Provider Demographics
NPI:1306583349
Name:INNOVATION COUNSELING SERVICES INC
Entity type:Organization
Organization Name:INNOVATION COUNSELING SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADEDAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-917-1380
Mailing Address - Street 1:8400 SNOWDEN LOOP
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2358
Mailing Address - Country:US
Mailing Address - Phone:240-838-2245
Mailing Address - Fax:
Practice Address - Street 1:8400 SNOWDEN LOOP
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2358
Practice Address - Country:US
Practice Address - Phone:240-838-2245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1003258971Medicaid