# LIFE SUPPORT CLINICAL COUNSELING SERVICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528538105
- **Authorized official:** MS. ALICE RITA HUNLEY LCPC (CEO)
- **Authorized official phone:** (410) 980-3163

## Contact information

- **Practice address:** 82 JANET DALE LN, SEVERN, MD 21144
- **Practice address phone:** (410) 980-3163
- **Practice address fax:** (410) 969-2958
- **Mailing address:** 82 JANET DALE LN, SEVERN, MD 21144
- **Mailing address phone:** (410) 980-3163
- **Mailing address fax:** (410) 969-2958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 11/27/2018
- **Last updated:** 11/27/2018