Healthcare Provider Details

I. General information

NPI: 1427815836
Provider Name (Legal Business Name): MR. XAVIER JUSTICE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 STANTON RD SE APT 303
WASHINGTON DC
20020-2256
US

IV. Provider business mailing address

3420 STANTON RD SE APT 303
WASHINGTON DC
20020-2256
US

V. Phone/Fax

Practice location:
  • Phone: 202-270-8525
  • Fax:
Mailing address:
  • Phone: 202-270-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number284933
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number00801-21-A
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPR0394
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number259
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: