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General NPI Number Information
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NPI Number | 1023584463
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Entity Type | Organization
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Legal Business Name | LOVE & LEGACY COUPLES COUNSELING INC
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 10632 LITTLE PATUXENT PKWY STE 340
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City | COLUMBIA
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State | MD
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Zip | 21044-6222
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Country | US
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Telephone | 443-968-4488
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Fax |
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Provider Business Mailing Address
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Address Line | 5939 FAIRLEE RD
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City | ELKRIDGE
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State | MD
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Zip | 21075-5422
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Country | US
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Telephone | 443-968-4488
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER/THERAPIST
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Name | SUSAN L WALKER
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Credential | LCSW-C
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Telephone | 443-968-4488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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