Provider Demographics
NPI:1194136739
Name:COUNCIL ROCK CONSULTING INC.
Entity type:Organization
Organization Name:COUNCIL ROCK CONSULTING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEHLENBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS BCBA
Authorized Official - Phone:301-881-7563
Mailing Address - Street 1:11821 PARKLAWN DR
Mailing Address - Street 2:STE 210
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2539
Mailing Address - Country:US
Mailing Address - Phone:301-881-7563
Mailing Address - Fax:
Practice Address - Street 1:483 N ARMISTEAD ST
Practice Address - Street 2:#103
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2819
Practice Address - Country:US
Practice Address - Phone:617-733-4972
Practice Address - Fax:301-881-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000183103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty