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General NPI Number Information
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NPI Number | 1821698242
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Entity Type | Organization
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Legal Business Name | PRIDE OF NYLA
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 11720 BELTSVILLE DR # 500-M2
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City | BELTSVILLE
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State | MD
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Zip | 20705-3166
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Country | US
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Telephone | 202-375-1024
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Fax |
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Provider Business Mailing Address
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Address Line | 11720 BELTSVILLE DR STE 500-M2
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City | BELTSVILLE
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State | MD
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Zip | 20705-3166
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Country | US
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Telephone | 202-375-1024
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Fax |
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Authorized Official
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Title or Position | OWNER-THERAPISTS
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Name | JASMINE PRICE
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Credential | LCPC-S
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Telephone | 202-375-1024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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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