21D2284971 CLIA NUMBER - KP COUNSELING SERVICES INC

Laboratory Demographics

CLIA Number: 21D2284971

Facility Name: KP COUNSELING SERVICES INC

Facility Address:
102 6TH AVENUE NE UNIT B
GLEN BURNIE, MD
ZIP 21060
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Facility Phone Number: 410 320-9967

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1871067603

Taxonomy: 101YA0400X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	21D2284971
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	KP COUNSELING SERVICES INC
Street	102 6TH AVENUE NE UNIT B
City	GLEN BURNIE
State	MD
ZIP	21060
Phone	410 320-9967
CertificateType	4
CertificateEffectiveDate	7/3/2023
CertificateExpirationDate	7/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024