Healthcare Provider Details

I. General information

NPI: 1750066304
Provider Name (Legal Business Name): THE BEHAVIORAL INTERVENTION REHABILITATION AND DEVELOPMENT PROJECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 OXON HILL RD
OXON HILL MD
20745-1117
US

IV. Provider business mailing address

6710 OXON HILL RD STE 210
OXON HILL MD
20745-1124
US

V. Phone/Fax

Practice location:
  • Phone: 704-606-8193
  • Fax:
Mailing address:
  • Phone: 240-557-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. EARLENE KIMBERLY DUNBAR
Title or Position: OWNER
Credential: LICSW, LCSW-C
Phone: 704-606-8193