Organization Name: | INTERDYNAMICS, INC. |
NPI Number: | 1013251826 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES MOSES BALLARD (PSYCHOLOGY) |
Mailing Address: | 4601 Forbes Blvd Lanham |
State: | MD US |
Postal Code: | 207064807 |
Phone Number: | 3013064590 |
Fax Number: | 3013064591 |
NPI Enumeration Date: | 11/16/2012 |
NPI Last Update Date: | 11/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | PSY354 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | DC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |