Healthcare Provider Details

I. General information

NPI: 1033880919
Provider Name (Legal Business Name): BBD PSYCHIATRY GROUP PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 15TH ST NW # NW600
WASHINGTON DC
20005-2605
US

IV. Provider business mailing address

1015 15TH ST NW STE 600
WASHINGTON DC
20005-2605
US

V. Phone/Fax

Practice location:
  • Phone: 202-656-6378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DERRICK BROOKS
Title or Position: CEO
Credential: MD
Phone: 202-743-5817