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General NPI Number Information
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NPI Number | 1649086729
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Entity Type | Organization
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Legal Business Name | PRODUCTIVE PSYCH LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 4690 MILLENNIUM DR STE 300
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City | BELCAMP
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State | MD
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Zip | 21017-1527
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Country | US
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Telephone | 410-656-9010
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Fax |
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Provider Business Mailing Address
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Address Line | 901 N BARRETT LN
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City | NEWARK
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State | DE
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Zip | 19702-6907
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Country | US
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Telephone | 302-440-6182
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICKOLAUS KING
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Credential | LCSW-C
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Telephone | 410-656-9010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #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 | 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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