Provider Demographics
NPI:1841572070
Name:BASICS THROUGH GROUP PRACTICE, LLC
Entity Type:Organization
Organization Name:BASICS THROUGH GROUP PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/VP
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-420-1972
Mailing Address - Street 1:11228 KETTERING PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1575
Mailing Address - Country:US
Mailing Address - Phone:202-427-2125
Mailing Address - Fax:
Practice Address - Street 1:11228 KETTERING PLACE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1575
Practice Address - Country:US
Practice Address - Phone:202-427-2125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500784241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty