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General NPI Number Information
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NPI Number | 1235444738
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Entity Type | Organization
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Legal Business Name | BASICS GROUP PRACTICE LLC
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 7610 PENNSYLVANIA AVE 103
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City | FORESTVILLE
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State | MD
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Zip | 20747-4701
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Country | US
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Telephone | 443-254-0966
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Fax | 301-423-5359
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Provider Business Mailing Address
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Address Line | 7610 PENNSYLVANIA AVE 103
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City | FORESTVILLE
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State | MD
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Zip | 20747-4701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | DANIEL NEGUSSIE FEREBEE
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Credential | LCSW-C
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Telephone | 443-254-0966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15032
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License Number State | MD
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