MEDICARE: BREATH OF FRESH AIR, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor
3	251S00000X	Community/Behavioral Health Agency
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1033934419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATH OF FRESH AIR, LLC

Provider Business Mailing Address
First Line	:	2010 COOPER POINT CT
Second Line	:
City	:	ODENTON
State	:	MD
Zip	:	21113-2918
Country	:	US
Telephone Number	:	301-613-1038
Fax Number	:	410-695-2998

Provider Business Practice Location Address
First Line	:	10001 DEREKWOOD LN STE 204
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4864
Country	:	US
Telephone Number	:	301-613-1038
Fax Number	:	410-695-2998

Authorized Official
Title or Position	:	CEO
Name	:	KIMBERLY DOWNING
Credential	:	LCPC
Telephone Number	:	301-613-1038

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	03/11/2026

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