Organization
BASICS GROUP PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL N FEREBEE (CEO)
(301) 420-1972
Entity
Organization
Contact information
Practice address
7610 PENNSYLVANIA AVE, SUITE #203, FORESTVILLE, MD 20747-4701
(301) 420-1972
(301) 420-1973
Mailing address
7610 PENNSYLVANIA AVE, SUITE #203, FORESTVILLE, MD 20747-4701
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
04481
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036596300
—
MD
05
—
417682100
—
MD
05
—
417682101
—
MD
Enumeration date
04/17/2012
Last updated
04/17/2012
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