Organization · NPI-2
About A Healthy Brain
Psychologist, Adult Development & Aging · Germantown, MD
NPI number1477237303
StatusActive
Last updated in NPPESJun 12, 2023
Details
- NPI
- 1477237303
- Entity type
- Organization (NPI-2)
- Legal business name
- About A Healthy Brain
- Organization subpart
- No
- Enumeration date
- Jun 12, 2023
- Certification date
- May 31, 2023
- Last updated
- Jun 12, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TA0700X | Psychologist, Adult Development & Aging | – | – | Yes |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – |
Practice location
19403 Buckingham WayGermantown, MD 20874-4665
Phone 240-756-1682
Mailing address
12774 Wisteria Dr2724
Germantown, MD 20875
Phone 240-756-1682
Authorized official
Debra April Latoak Lee
Nurse Practitioner
2407561682
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