| The Body Image Therapy Center Llc | |
|
8940 Old Annapolis Rd Suite E Columbia MD 21045-2129 | |
| (443) 602-6515 | |
| (443) 546-1100 |
| Full Name | The Body Image Therapy Center Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 8940 Old Annapolis Rd, Columbia, Maryland |
| Authorized Official Name and Position | Andrew Walen (OWNER, EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4436026515 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Body Image Therapy Center Llc 8940 Old Annapolis Rd Suite E Columbia MD 21045-2129 Ph: (443) 602-6515 | The Body Image Therapy Center Llc 8940 Old Annapolis Rd Suite E Columbia MD 21045-2129 Ph: (443) 602-6515 |
| NPI Number | 1609163450 |
|---|---|
| Provider Enumeration Date | 06/30/2011 |
| Last Update Date | 06/30/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609163450 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LC3911 (Maryland) | Secondary |
| 1041C0700X | Social Worker - Clinical | 15245 (Maryland) | Primary |
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