Healthcare Provider Details

I. General information

NPI: 1235585472
Provider Name (Legal Business Name): MSB COUNSELING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 SMALLWOOD DRIVE W, SUITE 460
WALDORF MD
20603
US

IV. Provider business mailing address

1282 SMALLWOOD DRIVE W, SUITE 460
WALDORF MD
20603
US

V. Phone/Fax

Practice location:
  • Phone: 443-538-1216
  • Fax:
Mailing address:
  • Phone: 443-538-1216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberLGPC4059
License Number StateMD

VIII. Authorized Official

Name: MS. MONIQUE SIMONE BROWN
Title or Position: OWNER/PRESIDENT
Credential: LCPC
Phone: 443-538-1216