NPIMap

Organization Active NPI

Southern Maryland Counseling & Coaching, LLC

Doing business as True Blue Behavioral Health

  • Clinical Social Worker
  • Waldorf, MD
National Provider Identifier
1285177600
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SOUTHERN MARYLAND COUNSELING & COACHING, LLC
Doing business as
True Blue Behavioral Health
Practice address
3261 Old Washington Rd Ste 2020
Waldorf, MD 20602-3231
Phone
(240) 435-4708
NPI assigned
Dec 2, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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

Authorized official

Name
Mrs. Davidra T Bazemore-Blue, LCSW-CNPI 1124465802
Title
Owner/Clinical Director
Phone
(202) 997-6060

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 19114 MD
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3261 Old Washington Rd Ste 2020
Waldorf, MD 20602-3231

Mailing address

16705 Rolling Tree Rd
Accokeek, MD 20607-3358
Phone (202) 997-6060

Other names 1

  • True Blue Behavioral Health Doing business as

National Provider Directory

National Provider Directory

Locations

3200 Crain Hwy
Ste 203
Waldorf, MD 20603
Phone (202) 567-9199

Practitioners & affiliated clinicians

Practitioners 1

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": "1480636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1285177600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16705 ROLLING TREE RD",
            "city": "ACCOKEEK",
            "state": "MD",
            "postal_code": "206073358",
            "telephone_number": "202-997-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3261 OLD WASHINGTON RD STE 2020",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023231",
            "telephone_number": "240-435-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MARYLAND COUNSELING & COACHING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-02",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A",
        "authorized_official_last_name": "BAZEMORE-BLUE",
        "authorized_official_first_name": "DAVIDRA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "202-997-6060",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "19114",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "True Blue Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; 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.