MEDICARE: CONGRUENT COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker
4	2084P0800X	Psychiatry Physician
5	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1043617970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONGRUENT COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	10630 LITTLE PATUXENT PKWY STE 209
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-6278
Country	:	US
Telephone Number	:	410-740-8066
Fax Number	:	410-740-8068

Provider Business Practice Location Address
First Line	:	7600 YORK RD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-7500
Country	:	US
Telephone Number	:	410-740-8066
Fax Number	:	410-740-8068

Authorized Official
Title or Position	:	CFO
Name	:	AMY ROTTIER
Credential	:
Telephone Number	:	443-917-2888

Provider Enumeration Date	:	11/20/2014
Last Update Date	:	07/26/2022

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