Provider Demographics
NPI:1053718981
Name:CONGRUENT COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:CONGRUENT COUNSELING SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LCADC
Authorized Official - Phone:410-740-8066
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6278
Mailing Address - Country:US
Mailing Address - Phone:410-740-8066
Mailing Address - Fax:410-740-8068
Practice Address - Street 1:8638 VETERANS HWY STE 301
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1422
Practice Address - Country:US
Practice Address - Phone:410-740-8066
Practice Address - Fax:410-740-8068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONGRUENT COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-20
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X, 2084P0800X, 101YP2500X
MD905838261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4231881-03Medicaid