Provider Demographics
NPI:1154740843
Name:IMPACT COUNSELING SOLUTIONS, P.A.
Entity type:Organization
Organization Name:IMPACT COUNSELING SOLUTIONS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GYEBI-FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:508-736-4797
Mailing Address - Street 1:2 W ROLLING CROSSROADS
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6208
Mailing Address - Country:US
Mailing Address - Phone:508-736-4797
Mailing Address - Fax:
Practice Address - Street 1:2 W ROLLING CROSSROADS
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6208
Practice Address - Country:US
Practice Address - Phone:508-736-4797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty