NPIMap

Organization Active NPI

Authentic Connections Therapeutic Services

  • Mental Health Counselor
  • Laurel, MD
National Provider Identifier
1205302585
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
AUTHENTIC CONNECTIONS THERAPEUTIC SERVICES
Practice address
8101 Sandy Spring Rd Ste 250
Laurel, MD 20707-3527
Phone
(202) 344-7933
Fax
(240) 366-5750
NPI assigned
Oct 15, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Kyana Bradley, LPC, LCPCNPI 1578052486
Title
President
Phone
(202) 344-7933

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X

Addresses

Primary practice location

8101 Sandy Spring Rd Ste 250
Laurel, MD 20707-3527

Mailing address

9783 Mountain Laurel Way Apt 2C
Laurel, MD 20723-6334
Phone (202) 344-7933

Other identifiers 1

IdentifierTypeStateIssuer
907084200MedicaidMD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1539561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1205302585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9783 MOUNTAIN LAUREL WAY APT 2C",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207236334",
            "telephone_number": "202-344-7933",
            "fax_number": "240-366-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8101 SANDY SPRING RD STE 250",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207073527",
            "telephone_number": "202-344-7933",
            "fax_number": "240-366-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTHENTIC CONNECTIONS THERAPEUTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-15",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "KYANA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "202-344-7933",
        "authorized_official_credential": "LPC, LCPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "907084200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.