| Restorative Behavior, Llc | |
|
9701 Apollo Dr Upper Marlboro MD 20774-4783 | |
| (301) 798-6125 | |
| (301) 355-0276 |
| Full Name | Restorative Behavior, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9701 Apollo Dr, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Ebonique Katress Mcclinnahan (OWNER AND CLINICIAN) |
| Authorized Official Contact | 9107971491 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restorative Behavior, Llc 9701 Apollo Dr Upper Marlboro MD 20774-4783 Ph: (301) 798-6125 | Restorative Behavior, Llc 9701 Apollo Dr Upper Marlboro MD 20774-4783 Ph: (301) 798-6125 |
| NPI Number | 1518613264 |
|---|---|
| Provider Enumeration Date | 02/22/2022 |
| Last Update Date | 03/04/2022 |
| Certification Date | 03/04/2022 |
| Medicare PECOS PAC ID | 0840677845 |
|---|---|
| Medicare Enrollment ID | O20220512001743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518613264 | NPI | - | NPPES |
| 6660066. | Other | MD | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Ebonique Katress Mcclinnahan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114562246 PECOS PAC ID: 0749613388 Enrollment ID: I20201125001561 |
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