Organization
TIDA HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDA MABELLE KONCHOU (PMHNP)
(240) 305-7446
Entity
Organization
Contact information
Practice address
2209 MONTAUK DR, CROFTON, MD 21114-3245
(240) 305-7446
Mailing address
2209 MONTAUK DR, CROFTON, MD 21114-3245
(240) 305-7446
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0015X
Psychosomatic Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
Other
Enumeration date
05/11/2023
Last updated
05/11/2023
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