NPIMap

Organization Active NPI

Institute for Behavioral Change, Inc.

  • Mental Health Counselor
  • Waldorf, MD
National Provider Identifier
1750084554
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
INSTITUTE FOR BEHAVIORAL CHANGE, INC.
Practice address
2670 Crain Hwy Ste 205
Waldorf, MD 20601-2816
Phone
(301) 818-0092
Fax
(301) 818-0110
NPI assigned
Mar 22, 2023
Last updated
Mar 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

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

Authorized official

Name
Devone Clarice Williams
Title
Coo
Phone
(301) 818-0092

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

2670 Crain Hwy Ste 205
Waldorf, MD 20601-2816

Mailing address

2670 Crain Hwy Ste 205
Waldorf, MD 20601-2816
Phone (301) 818-0092

Other names 1

  • IBC Other name

National Provider Directory

National Provider Directory
Tax ID family
Ibc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1679443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1750084554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 CRAIN HWY STE 205",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012816",
            "telephone_number": "301-818-0092",
            "fax_number": "301-818-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2670 CRAIN HWY STE 205",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012816",
            "telephone_number": "301-818-0092",
            "fax_number": "301-818-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR BEHAVIORAL CHANGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-22",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "DEVONE",
        "authorized_official_middle_name": "CLARICE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "301-818-0092"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IBC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Mar 22, 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.