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General NPI Number Information
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NPI Number | 1669093027
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Entity Type | Organization
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Legal Business Name | REDEEMED INNOCENCE LLC
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 9701 APOLLO DR STE 100
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City | LARGO
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State | MD
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Zip | 20774-4785
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Country | US
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Telephone | 301-412-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 12138 CENTRAL AVE # 673
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City | MITCHELLVILLE
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State | MD
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Zip | 20721-1910
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Country | US
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Telephone | 301-412-4343
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BROOKE JANET BEANDER
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Credential | MSW, LICSW, LCSW-C
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Telephone | 301-412-4343
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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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