Provider Demographics
NPI:1952999203
Name:PARADIGM SHIFT PSYCHOLOGICAL WELLNESS COLLECTIVE PC
Entity Type:Organization
Organization Name:PARADIGM SHIFT PSYCHOLOGICAL WELLNESS COLLECTIVE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELISHIA
Authorized Official - Middle Name:MARKAYLE
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-930-2134
Mailing Address - Street 1:3703 40TH PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1610
Mailing Address - Country:US
Mailing Address - Phone:602-628-7008
Mailing Address - Fax:
Practice Address - Street 1:3703 40TH PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MD
Practice Address - Zip Code:20722-1610
Practice Address - Country:US
Practice Address - Phone:602-628-7008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty