Provider Demographics
NPI:1891039673
Name:INTERDYNAMICS, INC.
Entity Type:Organization
Organization Name:INTERDYNAMICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ASSO ALCOHOL&DRUG COUNSEL
Authorized Official - Prefix:MS
Authorized Official - First Name:ASNEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:301-306-4590
Mailing Address - Street 1:4601 FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4807
Mailing Address - Country:US
Mailing Address - Phone:301-306-4590
Mailing Address - Fax:301-306-4591
Practice Address - Street 1:4601 FORBES BLVD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4807
Practice Address - Country:US
Practice Address - Phone:301-306-4590
Practice Address - Fax:301-306-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1766101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty