Provider Demographics
NPI:1366785370
Name:JAMES PRESANT
Entity type:Organization
Organization Name:JAMES PRESANT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:PRESANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC, LCSW
Authorized Official - Phone:301-861-0388
Mailing Address - Street 1:3060 MITCHELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1389
Mailing Address - Country:US
Mailing Address - Phone:301-861-0388
Mailing Address - Fax:
Practice Address - Street 1:3060 MITCHELLVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1389
Practice Address - Country:US
Practice Address - Phone:301-861-0388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12807251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0440361Medicaid