Healthcare Provider Details

I. General information

NPI: 1780351890
Provider Name (Legal Business Name): TRANSFORMATION IN COLOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 FORBES BLVD STE 208
LANHAM MD
20706-4823
US

IV. Provider business mailing address

PO BOX 1519
TEMPLE HILLS MD
20757-1519
US

V. Phone/Fax

Practice location:
  • Phone: 240-709-6557
  • Fax:
Mailing address:
  • Phone: 240-709-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. DA'KEISHA MOLIQUE JOHNSON
Title or Position: COUNSELOR
Credential: MA, LCPC, ACS, CGP
Phone: 240-709-6557