Provider Demographics
NPI:1437602588
Name:AMERICAN CENTER FOR INTELLECTUAL AND DIVERSE DISORDERS FOR COUNSELING,
Entity Type:Organization
Organization Name:AMERICAN CENTER FOR INTELLECTUAL AND DIVERSE DISORDERS FOR COUNSELING,
Other - Org Name:ACIDD FOR COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-377-0750
Mailing Address - Street 1:300 THOMAS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4700
Mailing Address - Country:US
Mailing Address - Phone:301-377-0750
Mailing Address - Fax:301-377-0463
Practice Address - Street 1:300 THOMAS DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4700
Practice Address - Country:US
Practice Address - Phone:301-377-0750
Practice Address - Fax:301-377-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty