Provider Demographics
NPI:1447628490
Name:BALTIMORE METROPOLITAN COUSNELING CENTER, LLC
Entity type:Organization
Organization Name:BALTIMORE METROPOLITAN COUSNELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:RIAZ
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:CAC-AD
Authorized Official - Phone:410-788-6407
Mailing Address - Street 1:17 WARREN RD STE 24A
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5012
Mailing Address - Country:US
Mailing Address - Phone:410-788-6407
Mailing Address - Fax:
Practice Address - Street 1:17 WARREN RD STE 24A
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5012
Practice Address - Country:US
Practice Address - Phone:410-788-6407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC-0313261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health