Basic Information
| Provider Information | |||||||||
| NPI: | 1922720788 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | D&A BEHAVIORAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3018 MARSH CROSSING DR | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207242972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012370394 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11890 HEALING WAY | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209047917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012370394 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2022 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | MENSAH | ||||||||
| AuthorizedOfficialFirstName: | AGNES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHIATRIC NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 3012370394 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | PROF. | ||||||||
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| AuthorizedOfficialCredential: | CRNP-PMH | ||||||||
| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.