Organization
IMARA COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID DEFOE (OWNER)
(301) 821-0049
Entity
Organization
Contact information
Practice address
8101 SANDY SPRING RD, 250, LAUREL, MD 20707-3596
(301) 821-0049
Mailing address
8101 SANDY SPRING RD, 250, LAUREL, MD 20707-3596
(301) 821-0049
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC6147
MD
101YP2500X
Professional Counselor
LC6147
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
718002100
—
MD
Enumeration date
09/22/2016
Last updated
10/15/2016
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