Healthcare Provider Details

I. General information

NPI: 1205363132
Provider Name (Legal Business Name): INSPIRED CONSULTING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 TAYLOR RD
RIVERDALE MD
20737-2000
US

IV. Provider business mailing address

5600 TAYLOR RD
RIVERDALE MD
20737-2000
US

V. Phone/Fax

Practice location:
  • Phone: 301-877-3721
  • Fax:
Mailing address:
  • Phone: 301-887-3721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number22228
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number22228
License Number StateMD

VIII. Authorized Official

Name: MR. COREY BEAUFORD
Title or Position: PRESIDENT
Credential: LCSW-C
Phone: 301-877-3721