Healthcare Provider Details

I. General information

NPI: 1730885104
Provider Name (Legal Business Name): OCD DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 CARNATION DR
ROCKVILLE MD
20850-2043
US

IV. Provider business mailing address

1104 CARNATION DR
ROCKVILLE MD
20850-2043
US

V. Phone/Fax

Practice location:
  • Phone: 240-401-3853
  • Fax:
Mailing address:
  • Phone: 240-401-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HANNAH MICHELE BRECKENRIDGE
Title or Position: OWNER
Credential: LCSW-C, LCSW, LICSW
Phone: 240-618-3581