| NPI | 1629768775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IDA MABELLE KONCHOU Pmhnp 240-305-7446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine | |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2023-05-11 |