Provider Demographics
NPI:1396384756
Name:IMARA COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:IMARA COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-581-1500
Mailing Address - Street 1:14502 GREENVIEW DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3287
Mailing Address - Country:US
Mailing Address - Phone:240-581-1500
Mailing Address - Fax:240-513-4122
Practice Address - Street 1:14502 GREENVIEW DR STE 202
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3287
Practice Address - Country:US
Practice Address - Phone:240-581-1500
Practice Address - Fax:240-513-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)