Healthcare Provider Details

I. General information

NPI: 1003586736
Provider Name (Legal Business Name): TABE NKI LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 KENNEDY ST NW
WASHINGTON DC
20011-3136
US

IV. Provider business mailing address

931 CASLON WAY APT 104
HYATTSVILLE MD
20785-6005
US

V. Phone/Fax

Practice location:
  • Phone: 202-313-7283
  • Fax:
Mailing address:
  • Phone: 240-510-8595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCACII200001243
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCACII200001243
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: