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General NPI Number Information
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NPI Number | 1548879505
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Entity Type | Organization
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Legal Business Name | ASDO BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 3261 OLD WASHINGTON RD STE 2020
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City | WALDORF
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State | MD
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Zip | 20602-3231
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Country | US
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Telephone | 301-263-3786
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Fax | 301-263-3804
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Provider Business Mailing Address
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Address Line | 6208 ERLAND WAY
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City | LANHAM
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State | MD
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Zip | 20706-2480
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Country | US
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Telephone | 301-263-3786
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Fax | 301-263-3804
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Authorized Official
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Title or Position | PRESIDENT
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Name | IJEOMA EMEKA
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Credential | PMHNP-BC
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Telephone | 240-481-9223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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