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NPI Code Detail

MEDICARE: KEMAH MAYO GBOLOKAI LGPC

MEDICARE:   KEMAH MAYO GBOLOKAI  LGPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLGP9649MD

General Provider Information

NPI Number : 1326694340
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEMAH MAYO GBOLOKAI LGPC
Provider Business Mailing Address
First Line : PO BOX 21331
Second Line :
City : WASHINGTON
State : DC
Zip : 20009-0831
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1420 COLUMBIA RD NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20009-4779
Country : US
Telephone Number : 202-400-7524
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2019
Last Update Date : 08/15/2019

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Directions to “ KEMAH MAYO GBOLOKAI LGPC” Practice Location

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