| Transformation Therapy Center Inc | |
|
10401 Hospital Dr Suite G-03 Clinton MD 20735-3110 | |
| (301) 856-6000 | |
| (301) 856-8389 |
| Full Name | Transformation Therapy Center Inc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 10401 Hospital Dr, Clinton, Maryland |
| Authorized Official Name and Position | Kellie I Jamison (LC SW-C) |
| Authorized Official Contact | 3018566000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Transformation Therapy Center Inc 10401 Hospital Dr Suite G-03 Clinton MD 20735-3110 Ph: (301) 856-6000 | Transformation Therapy Center Inc 10401 Hospital Dr Suite G-03 Clinton MD 20735-3110 Ph: (301) 856-6000 |
| NPI Number | 1609190750 |
|---|---|
| Provider Enumeration Date | 03/18/2010 |
| Last Update Date | 08/31/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609190750 | NPI | - | NPPES |
| 10425 | Other | MD | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 04071 (Maryland) | Secondary |
| 1041C0700X | Social Worker - Clinical | 10425 (Maryland) | Primary |
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