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General NPI Number Information
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NPI Number | 1538533641
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Entity Type | Organization
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Legal Business Name | CLEAR CONSCIOUS LLC
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 2115 GWYNN OAK AVE
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City | GWYNN OAK
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State | MD
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Zip | 21207-6004
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Country | US
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Telephone | 443-584-3758
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Fax |
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Provider Business Mailing Address
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Address Line | 2115 GWYNN OAK AVE
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City | GWYNN OAK
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State | MD
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Zip | 21207-6004
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Country | US
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Telephone | 443-584-3758
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/COUNSELOR
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Name | MRS. KAREN GARNER
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Credential | LCPC MBA
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Telephone | 443-584-3758
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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 | LC2228
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License Number State | MD
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