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General NPI Number Information
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NPI Number | 1124298484
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR BEHAVIORAL CHANGE, INC.
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 2670 CRAIN HWY STE 205
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City | WALDORF
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State | MD
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Zip | 20601-2816
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Country | US
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Telephone | 301-818-0092
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Fax | 301-818-0110
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Provider Business Mailing Address
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Address Line | 2670 CRAIN HWY STE 205
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City | WALDORF
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State | MD
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Zip | 20601-2816
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Country | US
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Telephone | 301-818-0092
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Fax | 301-818-0110
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Authorized Official
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Title or Position | CEO
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Name | DR. HOWARD MABRY
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Credential | PHD
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Telephone | 301-818-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 103000A-DT-Y-068
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC301420
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 1652
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License Number State | DC
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