Healthcare Provider Details
I. General information
NPI: 1699242925
Provider Name (Legal Business Name): WOODLEY PSYCHOANALYTIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2604 CONNECTICUT AVE NW STE 202
WASHINGTON DC
20008-1595
US
IV. Provider business mailing address
2604 CONNECTICUT AVE NW STE 202
WASHINGTON DC
20008-1595
US
V. Phone/Fax
- Phone: 202-505-4063
- Fax:
- Phone: 202-505-4063
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101Y00000X |
| Taxonomy | Counselor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ANNA
CHUNG
Title or Position: OWNER
Credential: PHD
Phone: 202-505-4063