Provider Demographics
NPI:1871085241
Name:AJS COUNSELING AND CONSULTING SERVICE, LLC
Entity type:Organization
Organization Name:AJS COUNSELING AND CONSULTING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WINNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-232-5554
Mailing Address - Street 1:1282 SMALLWOOD DR W # 162
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4732
Mailing Address - Country:US
Mailing Address - Phone:240-232-5555
Mailing Address - Fax:
Practice Address - Street 1:4703 OLD SOPER RD STE R1
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4030
Practice Address - Country:US
Practice Address - Phone:240-232-5554
Practice Address - Fax:240-607-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD116154700Medicaid