MEDICARE: INTEGRATIVE COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		MD

General Provider Information

NPI Number	:	1043422348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE COUNSELING

Provider Business Mailing Address
First Line	:	10630 LITTLE PATUXENT PKWY
Second Line	:	STE 209A
City	:	COLUMBIA
State	:	MD
Zip	:	21044-6278
Country	:	US
Telephone Number	:	410-740-8067
Fax Number	:	410-740-8068

Provider Business Practice Location Address
First Line	:	10630 LITTLE PATUXENT PKWY
Second Line	:	STE 209A
City	:	COLUMBIA
State	:	MD
Zip	:	21044-6278
Country	:	US
Telephone Number	:	410-740-8067
Fax Number	:	410-740-8068

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK D DONOVAN
Credential	:	LCPC, LCADC
Telephone Number	:	410-740-8067

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	02/19/2021

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