1063940104 NPI number — ALLUVION COUNSELING, LLC

Table of content: (NPI 1063940104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063940104 NPI number — ALLUVION COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLUVION COUNSELING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063940104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 CRANBROOK RD STE 161
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCKEYSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21030-3404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-687-8825
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W RIDGELY RD STE 8A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-5124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-687-8825
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BARBERIO
Authorized Official First Name:
ABIGAIL
Authorized Official Middle Name:
QUISH
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
443-687-8825

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LC5687 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 077575400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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