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General NPI Number Information
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NPI Number | 1487184966
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Entity Type | Organization
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Legal Business Name | IME BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 8850 STANFORD BLVD STE 1950
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City | COLUMBIA
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State | MD
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Zip | 21045-4889
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Country | US
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Telephone | 240-512-0141
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Fax | 240-512-0151
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Provider Business Mailing Address
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Address Line | 8850 STANFORD BLVD STE 1950
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City | COLUMBIA
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State | MD
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Zip | 21045-4889
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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 | CLINICAL THERPIST
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Name | MRS. ERICA DIXON
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Credential | LCPC, LCADC
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Telephone | 240-512-0141
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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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