Provider Demographics
NPI:1124722178
Name:CONGRUENT COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:CONGRUENT COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LCADC
Authorized Official - Phone:410-740-8066
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6278
Mailing Address - Country:US
Mailing Address - Phone:410-740-8066
Mailing Address - Fax:410-740-8068
Practice Address - Street 1:1643 LIBERTY RD STE 203
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6543
Practice Address - Country:US
Practice Address - Phone:410-740-8066
Practice Address - Fax:410-740-8068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONGRUENT COUNSELING SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty