Provider Demographics
NPI:1134486079
Name:BASICS GROUP PRACTICE, LLC
Entity Type:Organization
Organization Name:BASICS GROUP PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:FEREBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-420-1972
Mailing Address - Street 1:7610 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7610 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4701
Practice Address - Country:US
Practice Address - Phone:301-420-1972
Practice Address - Fax:301-420-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417682100Medicaid
MD036596300Medicaid
MD417682101Medicaid