Healthcare Provider Details

I. General information

NPI: 1295391621
Provider Name (Legal Business Name): B. TRANSFORMED CONSULTING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 OLD WASHINGTON RD STE 225
WALDORF MD
20602-3201
US

IV. Provider business mailing address

PO BOX 872
LA PLATA MD
20646-0872
US

V. Phone/Fax

Practice location:
  • Phone: 301-885-7579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YVETTE BISHOP
Title or Position: CEO/THERAPIST
Credential: LCPC
Phone: 301-885-7579