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Organization
THE BODY IMAGE THERAPY CENTER LLC
Active
Organization
THE BODY IMAGE THERAPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW WALEN LCSW-C (OWNER, EXECUTIVE DIRECTOR)
(443) 602-6515
Entity
Organization
Contact information
Practice address
8940 OLD ANNAPOLIS RD, SUITE E, COLUMBIA, MD 21045-2129
(443) 602-6515
(443) 546-1100
Mailing address
8940 OLD ANNAPOLIS RD, SUITE E, COLUMBIA, MD 21045-2129
(443) 602-6515
(443) 546-1100
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LC3911
MD
1041C0700X
Clinical Social Worker
Primary
15245
MD
Other
Enumeration date
06/30/2011
Last updated
06/30/2011
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