Organization
ADAPTIVE THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLIMPIA F ETTS LCSW (PARTNER)
(917) 576-7237
Entity
Organization
Contact information
Practice address
109 LA GRANGE AVE, SUITE 102, LA PLATA, MD 20646-9592
(240) 253-7051
(301) 934-2640
Mailing address
6015 NEW FOREST CT, APT 5, WALDORF, MD 20603-4735
(240) 607-9207
(301) 934-2640
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
15217
MD
Other
Enumeration date
02/09/2016
Last updated
02/09/2016
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