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General NPI Number Information
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NPI Number | 1255625844
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Entity Type | Organization
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Legal Business Name | YULA PONTICAS, PH.D., P.A.
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 1104 KENILWORTH DR SUITE 210
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City | TOWSON
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State | MD
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Zip | 21204-2101
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Country | US
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Telephone | 410-828-8824
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Fax | 410-828-8823
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Provider Business Mailing Address
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Address Line | 1104 KENILWORTH DR SUITE 210
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City | TOWSON
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State | MD
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Zip | 21204-2101
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Country | US
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Telephone | 410-828-8824
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Fax | 410-828-8823
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YULA PONTICAS
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Credential | PH.D.
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Telephone | 410-828-8824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 02426
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License Number State | MD
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