Provider Demographics
NPI:1477013258
Name:AYA BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:AYA BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LPC, LCPC
Authorized Official - Phone:202-716-1201
Mailing Address - Street 1:104 STEEPLE CHASE WAY APT E
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1132
Mailing Address - Country:US
Mailing Address - Phone:202-716-1201
Mailing Address - Fax:
Practice Address - Street 1:1638 R ST NW STE 311
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6446
Practice Address - Country:US
Practice Address - Phone:202-746-5838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1427585694Medicaid