Healthcare Provider Details

I. General information

NPI: 1477350858
Provider Name (Legal Business Name): ALLY BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8818 CENTRE PARK DR FL 2
COLUMBIA MD
21045-2159
US

IV. Provider business mailing address

1410 SPRING HILL RD STE 305
MC LEAN VA
22102-3020
US

V. Phone/Fax

Practice location:
  • Phone: 240-342-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOEY YOON
Title or Position: BUSINESS ANALYST
Credential:
Phone: 301-450-4086