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General NPI Number Information
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NPI Number | 1275927683
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Entity Type | Organization
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Legal Business Name | MERGENCE, INC
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 5209 YORK RD SUITE 15
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City | BALTIMORE
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State | MD
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Zip | 21212-4225
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Country | US
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Telephone | 301-769-6402
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Fax |
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Provider Business Mailing Address
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Address Line | 5209 YORK RD B-10
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City | BALTIMORE
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State | MD
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Zip | 21212-4225
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Country | US
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Telephone | 301-769-6402
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER/CLINICAL CONSULTANT
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Name | MS. TIESHA MIA COHEN
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Credential | LCPC
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Telephone | 301-769-6402
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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 | LC6047
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License Number State | MD
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