MEDICARE: PATAPSCO INTEGRATIVE COUNSELING, LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629941778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATAPSCO INTEGRATIVE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	879 OELLA AVE
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4729
Country	:	US
Telephone Number	:	443-383-0795
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 ELLICOTT MILLS DR STE B
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4638
Country	:	US
Telephone Number	:	443-383-0795
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	REBECCA DRURY
Credential	:	LGPC
Telephone Number	:	443-383-0795

Provider Enumeration Date	:	09/25/2025
Last Update Date	:	09/25/2025

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