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General NPI Number Information
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NPI Number | 1225853484
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Entity Type | Organization
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Legal Business Name | AYA BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1401 MERCANTILE LN STE 500A
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City | LARGO
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State | MD
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Zip | 20774-4301
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Country | US
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Telephone | 202-746-5838
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 LORTON AVE
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City | CAPITOL HEIGHTS
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State | MD
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Zip | 20743-5257
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Country | US
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Telephone | 202-716-1201
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICIAN
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Name | DR. SAMANTHA KNOX
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Credential | LPC
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Telephone | 202-716-1201
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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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