Organization
LIFE SUPPORT CLINICAL COUNSELING SERVICE LLC/PRP
Active
Parent organization
LIFE SUPPORT CLINICAL COUNSELING SERVICE LLC
Other names
Life Support Clinical Counseling Service LLC/PRP, Life Support Clinical Counseling Service LLC/PRP
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFE SUPPORT CLINICAL COUNSELING SERVICE LLC
Authorized official
ALICE RITA HUNLEY LCPC (OWNER)
(410) 980-3163
Entity
Organization
Contact information
Practice address
1412 CRAIN HWY N STE 6B, GLEN BURNIE, MD 21061-9306
(410) 980-3163
(410) 969-2958
Mailing address
825 JANET DALE LN, SEVERN, MD 21144-2789
(410) 980-3163
(410) 969-2958
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H-540-048-738-351
DRIVER LICENSE
MD
Enumeration date
02/20/2020
Last updated
02/20/2020
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