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Organization
THE INDIGO CHILD THERAPEUTIC LLC
Active
Organization
THE INDIGO CHILD THERAPEUTIC LLC
Active
Other names
The Indigo Child Therapeutic, TIC Therapeutic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TIFFANY DICKS (OWNER)
(240) 244-9778
Entity
Organization
Contact information
Practice address
7491 OLD ALEXANDRIA FERRY RD, CLINTON, MD 20772
(202) 277-5378
(240) 269-7799
Mailing address
9722 GREEN APPLE TURN, UPPER MARLBORO, MD 20772-4423
(202) 277-5378
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
444331400
—
MD
Enumeration date
09/24/2020
Last updated
10/23/2024
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