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General NPI Number Information
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NPI Number | 1194085928
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Entity Type | Organization
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Legal Business Name | ALDON
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Dates
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Enumeration Date | 05/27/2012
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Last Update Date | 05/27/2012
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Provider Practice Location Address
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Address Line | 7105 PONY TRAIL LN
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City | HYATTSVILLE
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State | MD
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Zip | 20782-1031
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Country | US
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Telephone | 240-667-4290
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Fax | 240-539-0216
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Provider Business Mailing Address
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Address Line | 8955 EDMONSTON RD SUITE E
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City | GREENBELT
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State | MD
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Zip | 20770-1006
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Country | US
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Telephone | 240-667-4290
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Fax | 240-539-0216
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Authorized Official
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Title or Position | PRESIDENT, CLINICAL DIRECTOR
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Name | DR. PHYLLIS BRAXTON ARNASONBRAXTONA
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Credential | LCPC
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Telephone | 240-667-4290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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