Organization
PERFORMANCE COMPLEX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUISE MACY (BILLING MGR)
(410) 298-8223
Entity
Organization
Contact information
Practice address
402 W PENNSYLVANIA AVENUE, TOWSON, MD 21204
(410) 298-8223
(410) 298-8225
Mailing address
14221 DOVE CREEK WAY UNIT 304, SPARKS, MD 21152-8814
(410) 771-4397
(410) 298-8225
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
09146
MD
Other
Enumeration date
05/14/2007
Last updated
08/22/2020
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