Healthcare Provider Details

I. General information

NPI: 1144053224
Provider Name (Legal Business Name): ALLY BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9256 BENDIX RD STE 102
COLUMBIA MD
21045-1843
US

IV. Provider business mailing address

1410 SPRING HILL RD
MC LEAN VA
22102-3058
US

V. Phone/Fax

Practice location:
  • Phone: 301-265-5617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

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