Healthcare Provider Details

I. General information

NPI: 1518982503
Provider Name (Legal Business Name): ALEK'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 FORBES BLVD # 122
LANHAM MD
20706-4342
US

IV. Provider business mailing address

4200 FORBES BLVD # 122
LANHAM MD
20706-4342
US

V. Phone/Fax

Practice location:
  • Phone: 301-731-0383
  • Fax: 301-731-2835
Mailing address:
  • Phone: 301-731-0383
  • Fax: 301-731-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLC1624
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLC1624
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberLC1624
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLC1624
License Number StateMD

VIII. Authorized Official

Name: MRS. KAREN CABBAGESTALK
Title or Position: EXECUTIVE OPERATIONAL DIRECTOR
Credential:
Phone: 301-731-0383