Provider Demographics
NPI:1932658671
Name:IMARA COUNSELING SERVICES
Entity Type:Organization
Organization Name:IMARA COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-821-0049
Mailing Address - Street 1:8101 SANDY SPRING RD
Mailing Address - Street 2:250
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3596
Mailing Address - Country:US
Mailing Address - Phone:301-821-0049
Mailing Address - Fax:
Practice Address - Street 1:8101 SANDY SPRING RD
Practice Address - Street 2:250
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3596
Practice Address - Country:US
Practice Address - Phone:301-821-0049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6147101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD718002100Medicaid