Basic Information
| Provider Information | |||||||||
| NPI: | 1376123778 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENSPACE COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10630 LITTLE PATUXENT PKWY STE 314J | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210446216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437662269 | ||||||||
| FaxNumber: | 8666290091 | ||||||||
| Practice Location | |||||||||
| Address1: | 10630 LITTLE PATUXENT PKWY STE 314J | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210446216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437662269 | ||||||||
| FaxNumber: | 4433191127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2021 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | PARIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/MHP | ||||||||
| AuthorizedOfficialTelephone: | 4437662269 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW-C | ||||||||
| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1588606305 | 05 | MD | MEDICAID |