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General NPI Number Information
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NPI Number | 1578028106
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Entity Type | Organization
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Legal Business Name | BODHI PSYCHOTHERAPY AND CONSULTING, LLC
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 518 S MAIN ST OFC 6
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3220
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Country | US
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Telephone | 443-670-7977
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Fax | 410-882-1079
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Provider Business Mailing Address
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Address Line | PO BOX 10960
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City | BALTIMORE
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State | MD
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Zip | 21234-0960
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Country | US
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Telephone | 410-882-7967
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Fax | 410-882-1079
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MARILYN RENEE GOLDMAN
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Credential | LCSW-C, LISW-CP
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Telephone | 410-602-2545
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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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