Healthcare Provider Details

I. General information

NPI: 1184027633
Provider Name (Legal Business Name): URBAN BEHAVIORAL ASSOCIATES DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3029 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-2506
US

IV. Provider business mailing address

2310 N CHARLES ST
BALTIMORE MD
21218-5127
US

V. Phone/Fax

Practice location:
  • Phone: 202-971-4051
  • Fax: 202-563-0109
Mailing address:
  • Phone: 410-779-3102
  • Fax: 410-230-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACEE BURROUGHS
Title or Position: CEO
Credential:
Phone: 410-779-3102