Provider Demographics
NPI:1902250582
Name:ORIGINS COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ORIGINS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-360-1917
Mailing Address - Street 1:6710 OXON HILL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1117
Mailing Address - Country:US
Mailing Address - Phone:240-360-1917
Mailing Address - Fax:
Practice Address - Street 1:6710 OXON HILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1117
Practice Address - Country:US
Practice Address - Phone:240-360-1917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5727251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health