Provider Demographics
NPI:1528629540
Name:MARYLAND VIRTUAL COUNSELING LLC,
Entity type:Organization
Organization Name:MARYLAND VIRTUAL COUNSELING LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTINE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCPC
Authorized Official - Phone:443-250-6653
Mailing Address - Street 1:642 THOMAS WAY
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2832
Mailing Address - Country:US
Mailing Address - Phone:443-250-6653
Mailing Address - Fax:
Practice Address - Street 1:4 KUETHE RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7322
Practice Address - Country:US
Practice Address - Phone:443-203-8098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health