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General NPI Number Information
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NPI Number | 1548878051
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Entity Type | Organization
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Legal Business Name | THE PHOCAL GROUP
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 14503 DRIFTWOOD RD
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City | BOWIE
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State | MD
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Zip | 20721-3062
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Country | US
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Telephone | 860-830-7598
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Fax |
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Provider Business Mailing Address
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Address Line | 14503 DRIFTWOOD RD
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City | BOWIE
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State | MD
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Zip | 20721-3062
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Country | US
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Telephone | 860-830-7598
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. ALISHA JEANETTE MITCHELL
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Credential | LCSW-C
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Telephone | 860-830-7598
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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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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