Provider Demographics
NPI:1427413244
Name:EMMANUEL COMMUNITY COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:EMMANUEL COMMUNITY COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/ FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:MOULTON
Authorized Official - Last Name:EADDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LCADC
Authorized Official - Phone:443-850-7589
Mailing Address - Street 1:2300 GARRISON BLVD
Mailing Address - Street 2:240
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2335
Mailing Address - Country:US
Mailing Address - Phone:410-412-7230
Mailing Address - Fax:
Practice Address - Street 1:3911 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-1229
Practice Address - Country:US
Practice Address - Phone:410-650-8334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty