Provider Demographics
NPI:1861053787
Name:PROGRESSIVE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:PROGRESSIVE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLY
Authorized Official - Middle Name:THREADGILL
Authorized Official - Last Name:OGUNGBEMI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-212-0111
Mailing Address - Street 1:3525H ELLICOTT MILLS DR STE 108
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4544
Mailing Address - Country:US
Mailing Address - Phone:410-212-0111
Mailing Address - Fax:
Practice Address - Street 1:3525H ELLICOTT MILLS DR STE 108
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4544
Practice Address - Country:US
Practice Address - Phone:410-212-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty