Organization
THE INDIGO CHILD THERAPEUTIC LLC
Active
Other names
The Indigo Child Therapeutic, TIC Therapeutic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TIFFANY DICKS (OWNER)
(240) 244-9778
Entity
Organization
Contact information
Practice address
7491 OLD ALEXANDRIA FERRY RD, CLINTON, MD 20772
(202) 277-5378
(240) 269-7799
Mailing address
9722 GREEN APPLE TURN, UPPER MARLBORO, MD 20772-4423
(202) 277-5378
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
444331400
—
MD
Enumeration date
09/24/2020
Last updated
10/23/2024
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