Active NPI
The Indigo Child Therapeutic LLC
- Speech-Language Pathologist
- Clinton, MD
National Provider Identifier
1912514910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Legal business name
- THE INDIGO CHILD THERAPEUTIC LLC
- Doing business as
- TIC Therapeutic
The Indigo Child Therapeutic - Practice address
- 7491 Old Alexandria Ferry Rd
Clinton, MD 20772 - Phone
- (202) 277-5378
- Fax
- (240) 269-7799
- NPI assigned
- Sep 24, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Tiffany Dicks
- Title
- Owner
- Phone
- (240) 244-9778
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 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Occupational Therapy Assistant | 224Z00000X | |||
| Physical Therapist | 225100000X | |||
| Occupational Therapist | 225X00000X | |||
| Speech-Language Assistant | 2355S0801X | |||
| Speech-Language Pathologist | 235Z00000X | Primary |
Addresses
Primary practice location
7491 Old Alexandria Ferry Rd
Clinton, MD 20772
Mailing address
9722 Green Apple Turn
Upper Marlboro, MD 20772-4423
Phone (202) 277-5378
Other practice location 1
7491 Old Alexandria Ferry Rd
Clinton, MD 20735-1845
Phone (240) 244-9778
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 444331400 | Medicaid | MD |
Other names 2
- TIC Therapeutic
- The Indigo Child Therapeutic
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Theindigochildtherapeutic@hotmail.com |
National Provider Directory
National Provider Directory- Tax ID family
- The Indigo Child Therapeutic
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Behavior Analyst
- Clinton, MD
- NPI 1386235323
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Speech-Language Pathologist
- Garden City, NY
- NPI 1629670849
-
- Behavior Technician
- Clinton, MD
- NPI 1780527598
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600905600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1729641600000",
"number": "1912514910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9722 GREEN APPLE TURN",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207724423",
"telephone_number": "202-277-5378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7491 OLD ALEXANDRIA FERRY RD",
"city": "CLINTON",
"state": "MD",
"postal_code": "20772",
"telephone_number": "202-277-5378",
"fax_number": "240-269-7799"
}
],
"practiceLocations": [
{
"address_1": "7491 Old Alexandria Ferry Rd",
"address_purpose": "LOCATION",
"city": "Clinton",
"state": "MD",
"postal_code": "207351845",
"country_code": "US",
"telephone_number": "240-244-9778",
"fax_number": "240-269-7799",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "THE INDIGO CHILD THERAPEUTIC LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-09-24",
"last_updated": "2024-10-23",
"certification_date": "2024-10-21",
"status": "A",
"authorized_official_last_name": "DICKS",
"authorized_official_first_name": "TIFFANY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "240-244-9778",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "224Z00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapy Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "2355S0801X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "444331400",
"state": "MD"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Theindigochildtherapeutic@hotmail.com",
"affiliation": "N",
"address_1": "9722 Green Apple Turn",
"city": "Upper Marlboro",
"state": "MD",
"country_code": "US",
"postal_code": "207724423",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "TIC Therapeutic",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "The Indigo Child Therapeutic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Clinton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.