| Life Support Clinical Counseling Service Llc/prp | |
|
1412 Crain Hwy N Ste 6b Glen Burnie MD 21061-9306 | |
| (410) 980-3163 | |
| (410) 969-2958 |
| Full Name | Life Support Clinical Counseling Service Llc/prp |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1412 Crain Hwy N Ste 6b, Glen Burnie, Maryland |
| Authorized Official Name and Position | Alice Rita Hunley (OWNER) |
| Authorized Official Contact | 4109803163 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Support Clinical Counseling Service Llc/prp 825 Janet Dale Ln Severn MD 21144-2789 Ph: (410) 980-3163 | Life Support Clinical Counseling Service Llc/prp 1412 Crain Hwy N Ste 6b Glen Burnie MD 21061-9306 Ph: (410) 980-3163 |
| NPI Number | 1477186278 |
|---|---|
| Provider Enumeration Date | 02/20/2020 |
| Last Update Date | 02/20/2020 |
| Certification Date | 02/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477186278 | NPI | - | NPPES |
| H-540-048-738-351 | Other | MD | DRIVER LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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