Healthcare Provider Details

I. General information

NPI: 1003320714
Provider Name (Legal Business Name): MELISSA CIMINO LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 RHODE ISLAND AVE NW
WASHINGTON DC
20001
US

IV. Provider business mailing address

915 RHODE ISLAND AVE. NW
WASHINGTON DC
20001
US

V. Phone/Fax

Practice location:
  • Phone: 202-232-6810
  • Fax:
Mailing address:
  • Phone: 202-232-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC00218
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: