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General NPI Number Information
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NPI Number | 1861907891
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS COUNSELING CENTER LLC
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 1425 LIBERTY RD STE 206
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City | ELDERSBURG
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State | MD
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Zip | 21784-6971
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Country | US
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Telephone | 410-995-8780
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Fax | 410-995-8784
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Provider Business Mailing Address
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Address Line | 5614 COMPTON LN
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City | ELDERSBURG
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State | MD
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Zip | 21784-8868
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Country | US
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Telephone | 410-995-8780
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Fax | 410-995-8784
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. DEBORAH LYNN DEVINCENT
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Credential | LCPC
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Telephone | 410-995-8780
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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 | LC6876
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License Number State | MD
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