Provider Demographics
NPI:1720696800
Name:DRABO, BRICE L
Entity Type:Individual
Prefix:
First Name:BRICE
Middle Name:L
Last Name:DRABO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 TIMBER GROVE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3099
Mailing Address - Country:US
Mailing Address - Phone:240-821-2879
Mailing Address - Fax:
Practice Address - Street 1:1948 TIMBER GROVE RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-3099
Practice Address - Country:US
Practice Address - Phone:240-821-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20-124132106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician