# RONALD GRAY MEDLIN, INSTITUTE OF LIFE AND HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437375615
- **Authorized official:** DR. RONALD GRAY MEDLIN PH.D., LCADC (OWNER,PROGRAM DIRECTOR)
- **Authorized official phone:** (301) 627-3007

## Contact information

- **Practice address:** 5311 WATER ST, SUITE D, UPPER MARLBORO, MD 20772-3056
- **Practice address phone:** (301) 627-3007
- **Mailing address:** 5311 WATER ST, SUITE D, UPPER MARLBORO, MD 20772-3056
- **Mailing address phone:** (301) 627-3007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | LCA352 | MD | — |
| 101YM0800X | Mental Health Counselor | LCA352 | MD | — |
| 103T00000X | Psychologist | LCA352 | MD | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | LCA352 | MD | Yes |
| 103TF0000X | Family Psychologist | LCA352 | MD | — |
| 103TH0100X | Health Service Psychologist | LCA352 | MD | — |
| 106H00000X | Marriage & Family Therapist | LCA352 | MD | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | LCA352 | MD | — |

## Other

- **Enumeration date:** 04/17/2007
- **Last updated:** 03/19/2013