Healthcare Provider Details

I. General information

NPI: 1649086729
Provider Name (Legal Business Name): PRODUCTIVE PSYCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10715 CHARTER DR STE 130
COLUMBIA MD
21044-2892
US

IV. Provider business mailing address

4690 MILLENNIUM DR STE 300
BELCAMP MD
21017-1527
US

V. Phone/Fax

Practice location:
  • Phone: 410-656-9010
  • Fax: 443-402-3945
Mailing address:
  • Phone: 410-656-9010
  • Fax: 443-402-3945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICKOLAUS KING
Title or Position: OWNER
Credential: LCSW-C
Phone: 410-656-9010