Provider Demographics
NPI:1063957900
Name:LC COUNSELING
Entity type:Organization
Organization Name:LC COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:RICKERT
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-404-8661
Mailing Address - Street 1:10506 WILLOW VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1038
Mailing Address - Country:US
Mailing Address - Phone:410-404-8661
Mailing Address - Fax:
Practice Address - Street 1:360 MAIN ST
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1919
Practice Address - Country:US
Practice Address - Phone:410-526-5387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD109711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104020874OtherCAREFIRST BLUE CROSS
1104020874OtherCIGNA
1174727846OtherCAREFIRST BLUE CROSS
1174727846OtherAETNA
MD1174727846Medicaid
1174727846OtherCIGNA
1104020874OtherAETNA
MD1104020874Medicaid