Provider Demographics
NPI:1619779048
Name:1 AXIUM, LLC
Entity type:Organization
Organization Name:1 AXIUM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:LOVE
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-808-2878
Mailing Address - Street 1:4041 POWDER MILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-0004
Mailing Address - Country:US
Mailing Address - Phone:202-808-2878
Mailing Address - Fax:202-808-2878
Practice Address - Street 1:4041 POWDER MILL RD STE 300
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-0004
Practice Address - Country:US
Practice Address - Phone:202-808-2878
Practice Address - Fax:202-292-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)