Provider Demographics
NPI:1871163394
Name:PARADIGM INTEGRATED BEHAVIORAL HEALTH AND WELLNESS GROUP
Entity type:Organization
Organization Name:PARADIGM INTEGRATED BEHAVIORAL HEALTH AND WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-379-2792
Mailing Address - Street 1:12138 CENTRAL AVE STE 163
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1910
Mailing Address - Country:US
Mailing Address - Phone:301-379-2792
Mailing Address - Fax:
Practice Address - Street 1:9600 MILESTONE WAY APT 3053
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-4273
Practice Address - Country:US
Practice Address - Phone:443-208-0676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty