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General NPI Number Information
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NPI Number | 1073345906
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Entity Type | Organization
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Legal Business Name | CENTER FOR ANXIETY AND BEHAVIORAL CHANGE
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 50 W. MONTGOMERY AVE SUITE 110
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City | ROCKVILLE
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State | MD
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Zip | 20850
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Country | US
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Telephone | 301-610-7850
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Fax | 240-238-3042
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Provider Business Mailing Address
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Address Line | 50 W. MONTGOMERY AVE SUITE 110
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City | ROCKVILLE
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State | MD
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Zip | 20850
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Country | US
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Telephone | 301-610-7850
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Fax | 240-238-3042
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/OWNER
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Name | JONATHAN DALTON
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Credential | PH.D.
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Telephone | 301-610-7850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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