Organization
SOUTH RIVER COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURI HEINLEIN MCCORMACK LCPC (OWNER)
(443) 994-1048
Entity
Organization
Contact information
Practice address
3428 CONSTELLATION DR, DAVIDSONVILLE, MD 21035-1341
(443) 994-1048
Mailing address
3428 CONSTELLATION DR, DAVIDSONVILLE, MD 21035-1341
(443) 994-1048
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LC4751
MD
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC4751
MD
101YM0800X
Mental Health Counselor
LC4751
MD
101YP2500X
Professional Counselor
LC4751
MD
106H00000X
Marriage & Family Therapist
LC4751
MD
Other
Enumeration date
03/14/2017
Last updated
03/14/2017
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