Provider Demographics
NPI:1699416669
Name:TARAH DAVIDSON LLC
Entity Type:Organization
Organization Name:TARAH DAVIDSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-200-4050
Mailing Address - Street 1:12774 WISTERIA DR UNIT 2954
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20875-7644
Mailing Address - Country:US
Mailing Address - Phone:240-200-4050
Mailing Address - Fax:
Practice Address - Street 1:19000 FOREST BROOK ROAD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874
Practice Address - Country:US
Practice Address - Phone:240-200-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TARAH DAVIDSON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD888386600Medicaid