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General NPI Number Information
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NPI Number | 1942663398
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Entity Type | Organization
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Legal Business Name | MARK GOLDBERG COUNSELING LLC
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Dates
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Enumeration Date | 04/02/2016
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Last Update Date | 04/02/2016
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Provider Practice Location Address
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Address Line | 104 CHURCH LN # 103
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City | PIKESVILLE
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State | MD
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Zip | 21208-3786
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Country | US
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Telephone | 443-835-6991
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Fax |
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Provider Business Mailing Address
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Address Line | 104 CHURCH LN # 103
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City | PIKESVILLE
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State | MD
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Zip | 21208-3786
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. MARK GOLDBERG
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Credential |
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Telephone | 443-835-6991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LGM568
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License Number State | MD
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