Provider Demographics
NPI:1194322149
Name:ONE OF A KIND CHILD AND ADOLESCENT PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:ONE OF A KIND CHILD AND ADOLESCENT PSYCHOTHERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMANOELLE A
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-220-1076
Mailing Address - Street 1:744 DULANEY VALLEY RD STE 160
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5132
Mailing Address - Country:US
Mailing Address - Phone:410-929-2404
Mailing Address - Fax:
Practice Address - Street 1:744 DULANEY VALLEY RD STE 7
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5132
Practice Address - Country:US
Practice Address - Phone:410-929-2404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty