Organization
INTERDYNAMICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES MOSES BALLARD JR. (PSYCHOLOGY)
(301) 306-4590
Entity
Organization
Contact information
Practice address
4601 FORBES BLVD, LANHAM, MD 20706-4807
(301) 306-4590
(301) 306-4591
Mailing address
4601 FORBES BLVD, LANHAM, MD 20706-4807
(301) 306-4590
(301) 306-4591
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
01160
MD
101YM0800X
Mental Health Counselor
PSY354
DC
101YP2500X
Professional Counselor
01160
MD
103T00000X
Psychologist
01160
MD
103T00000X
Psychologist
PSY354
DC
103TA0700X
Adult Development & Aging Psychologist
PSY354
DC
103TB0200X
Cognitive & Behavioral Psychologist
01160
MD
103TC0700X
Clinical Psychologist
01160
MD
103TC0700X
Clinical Psychologist
PSY354
DC
103TC1900X
Counseling Psychologist
01160
MD
103TC2200X
Clinical Child & Adolescent Psychologist
01160
MD
103TC2200X
Clinical Child & Adolescent Psychologist
PSY354
DC
103TF0000X
Family Psychologist
01160
MD
106H00000X
Marriage & Family Therapist
01160
MD
106H00000X
Marriage & Family Therapist
PSY354
DC
Other
Enumeration date
11/16/2012
Last updated
11/16/2012
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