Provider Information for 1518613264
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
RESTORATIVE BEHAVIOR, LLC
Organization Subpart: NO
NPI: 1518613264
Last Updated: 2022-03-04
Certification Date: 2022-03-04
Certification Date: 2022-03-04
Details
Name | Value | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
NPI | 1518613264 | ||||||||||||||
Enumeration Date | 2022-02-22 | ||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||
Status | Active | ||||||||||||||
Authorized Official Information | Name: Ms. EBONIQUE KATRESS MCCLINNAHAN RN, MSN, PMHNP-BC Title: Owner and Clinician Phone: 9107971491 | ||||||||||||||
Mailing Address | 9701 APOLLO DR UPPER MARLBORO, MD 20774-4783 United States Phone: 301-798-6125 | Fax:301-355-0276 | ||||||||||||||
Primary Practice Address | 9701 APOLLO DR UPPER MARLBORO, MD 20774-4783 United States Phone: 301-798-6125 | Fax:301-355-0276 | ||||||||||||||
Secondary Practice Address(es) | |||||||||||||||
Health Information Exchange |
| ||||||||||||||
Other Identifiers |
| ||||||||||||||
Taxonomy |
|