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General NPI Number Information
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NPI Number | 1184186199
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Entity Type | Organization
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Legal Business Name | NOTABLE LIFE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 2107-2109 LAUREL BUSH ROAD, STE 103B
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City | BEL AIR
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State | MD
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Zip | 21015
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Country | US
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Telephone | 240-706-5506
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Fax |
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Provider Business Mailing Address
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Address Line | 9 BRAMLEIGH RD
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City | LUTHERVILLE TIMONIUM
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State | MD
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Zip | 21093-5708
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Country | US
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Telephone | 240-706-5506
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONY KUSNADI
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Credential | MD
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Telephone | 240-706-5506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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