Organization
RESTORATIVE BEHAVIOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EBONIQUE KATRESS MCCLINNAHAN RN, MSN, PMHNP-BC (OWNER AND CLINICIAN)
(910) 797-1491
Entity
Organization
Contact information
Practice address
9701 APOLLO DR, UPPER MARLBORO, MD 20774-4783
(301) 798-6125
(301) 355-0276
Mailing address
9701 APOLLO DR, UPPER MARLBORO, MD 20774-4783
(301) 798-6125
(301) 355-0276
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6660066.
AETNA
MD
Enumeration date
02/22/2022
Last updated
03/04/2022
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