Healthcare Provider Details

I. General information

NPI: 1952883159
Provider Name (Legal Business Name): PEACE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W. CHESAPEAKE AVE
TOWSON MD
21204
US

IV. Provider business mailing address

160 BAHNS MILL RD
RED LION PA
17356
US

V. Phone/Fax

Practice location:
  • Phone: 717-873-1836
  • Fax:
Mailing address:
  • Phone: 717-873-1836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2126
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08434
License Number StateMD

VIII. Authorized Official

Name: MRS. PATRICIA SCHLOUGH
Title or Position: COUNSELOR/OWNER
Credential: LCPC
Phone: 717-873-1836