Healthcare Provider Details

I. General information

NPI: 1437415866
Provider Name (Legal Business Name): CYNTHIA LARDELL JAMISON LPC, LCADC, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 43RD PL NE
WASHINGTON DC
20019-3713
US

IV. Provider business mailing address

6703 JAMES FARMER WAY
CAPITOL HEIGHTS MD
20743-2150
US

V. Phone/Fax

Practice location:
  • Phone: 202-399-1107
  • Fax: 202-399-1778
Mailing address:
  • Phone: 301-350-3931
  • Fax: 301-324-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA359
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC16
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: