1861036436 NPI number — THE PSYCHOTHERAPY AND BEHAVIORAL HEALTH NETWORK

Table of content: (NPI 1861036436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861036436 NPI number — THE PSYCHOTHERAPY AND BEHAVIORAL HEALTH NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PSYCHOTHERAPY AND BEHAVIORAL HEALTH NETWORK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861036436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 ELLINGTON BOULEVARD PMB 509
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-428-0465
Provider Business Mailing Address Fax Number:
240-846-3721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44679 ENDICOTT DR
Provider Second Line Business Practice Location Address:
STE 300 #431
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-428-0465
Provider Business Practice Location Address Fax Number:
240-846-3721
Provider Enumeration Date:
11/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ADIKA
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PSYCHOTHERAPIST/OWNER
Authorized Official Telephone Number:
240-428-0465

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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