David Imamu Defoe

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LC6147 Issued in MD

Practice address

14502 Greenview Dr Ste 202
Laurel, MD 20708-3287

Phone

(301) 821-0049

Fax

(240) 513-4122

NPI assigned

Aug 26, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Imara Counseling Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Laurel, MD
  • NPI 1396384756
  NPD Authorized official
• Oasis of Mind, LLC

  • Mental Health Counselor
  • Glen Burnie, MD
  • NPI 1720761877
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1124452123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14502 GREENVIEW DR STE 202",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083287",
            "telephone_number": "240-581-1500",
            "fax_number": "240-513-4122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14502 GREENVIEW DR STE 202",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083287",
            "telephone_number": "301-821-0049",
            "fax_number": "240-513-4122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFOE",
        "first_name": "DAVID",
        "middle_name": "IMAMU",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-26",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC6147",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC6147",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "873928",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• De Shanique Enterprise LLC
• Decker & Lavine, DDS, PA
• Dedicated Care Services LLC
• Dedicated Transportation Services LLC
• Deep Kukreti and Associates, LLC
• Denise Lynnette Defoe, LMSW
• Jocelyn Beville Defoe, D.D.S.
• Defyd Services LLC
• Gail Hilseberg Deitsch, COTA L
• Lizeth Noemy Del Cid

• Mental Health Counselor in Laurel, MD
• Providers in Laurel, MD by specialty
• Mental Health Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.