Healthcare Provider Details

I. General information

NPI: 1548879505
Provider Name (Legal Business Name): ASDO BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 OLD WASHINGTON RD STE 2020
WALDORF MD
20602-3231
US

IV. Provider business mailing address

6208 ERLAND WAY
LANHAM MD
20706-2480
US

V. Phone/Fax

Practice location:
  • Phone: 301-263-3786
  • Fax: 301-263-3804
Mailing address:
  • Phone: 301-263-3786
  • Fax: 301-263-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IJEOMA EMEKA
Title or Position: PRESIDENT
Credential: PMHNP-BC
Phone: 240-481-9223