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General NPI Number Information
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NPI Number | 1487325866
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Entity Type | Organization
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Legal Business Name | INTROSPECTION COUNSELING CENTER LLC
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Dates
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Enumeration Date | 09/24/2021
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 10770 COLUMBIA PIKE STE 300
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City | SILVER SPRING
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State | MD
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Zip | 20901-4439
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Country | US
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Telephone | 302-213-6158
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Fax | 855-530-2764
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Provider Business Mailing Address
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Address Line | 2300 PENNSYLVANIA AVE UNIT LLC
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City | WILMINGTON
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State | DE
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Zip | 19806-1392
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Country | US
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Telephone | 302-213-6158
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Fax | 855-530-2764
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Authorized Official
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Title or Position | OWNER
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Name | DIERDRA ORETADE-BRANCH
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Credential | DSW, LCSW, BCD
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Telephone | 302-213-6158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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