Healthcare Provider Details

I. General information

NPI: 1336204965
Provider Name (Legal Business Name): JENNY LYNNE PERHAM LCSW,CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW BLDG 6, FLOOR 2, WRAMC
WASHINGTON DC
20307-0003
US

IV. Provider business mailing address

PO BOX 26003
ARLINGTON VA
22215-6003
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-3969
  • Fax: 202-782-7589
Mailing address:
  • Phone: 571-275-0247
  • Fax: 703-521-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1199-04
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3131
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: