MEDICARE: DIVERSIFIED COUNSELING SERVICES, 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	251S00000X	Community/Behavioral Health Agency	09930	MD

General Provider Information

NPI Number	:	1659744266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSIFIED COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	9135 PISCATAWAY RD STE 220
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2542
Country	:	US
Telephone Number	:	301-856-3636
Fax Number	:	866-422-8982

Provider Business Practice Location Address
First Line	:	9135 PISCATAWAY RD STE 220
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2542
Country	:	US
Telephone Number	:	301-856-3636
Fax Number	:	866-422-8982

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLYN GERALDINE DAWKINS
Credential	:	LCSWC
Telephone Number	:	301-651-2921

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	05/10/2024

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