Healthcare Provider Details

I. General information

NPI: 1497996441
Provider Name (Legal Business Name): THE CONNECTION THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 PARLIAMENT PLACE SUITE A
LANHAM MD
20706
US

IV. Provider business mailing address

4451 PARLIAMENT PLACE SUITE A
LANHAM MD
20706
US

V. Phone/Fax

Practice location:
  • Phone: 301-577-4333
  • Fax: 301-577-5180
Mailing address:
  • Phone: 301-577-4333
  • Fax: 301-577-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. KEISHA LYNN MATTHEWS-BERRY
Title or Position: DIRECTOR
Credential: MS, CCC-SLP
Phone: 301-577-4333