MEDICARE: TRADITIONAL AND SPIRITUAL COUNSELING INC.

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	1041C0700X	Clinical Social Worker	07228	MD

General Provider Information

NPI Number	:	1578630083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRADITIONAL AND SPIRITUAL COUNSELING INC.

Provider Business Mailing Address
First Line	:	2702 ALLENDALE RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-2133
Country	:	US
Telephone Number	:	410-664-4758
Fax Number	:	410-664-9399

Provider Business Practice Location Address
First Line	:	2702 ALLENDALE RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-2133
Country	:	US
Telephone Number	:	410-664-4758
Fax Number	:	410-664-9399

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. OMIRA LEE
Credential	:	LCSW-C
Telephone Number	:	410-664-4758

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	11/19/2007

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