Healthcare Provider Details

I. General information

NPI: 1164151155
Provider Name (Legal Business Name): CAREN ASHLEE GILLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 L ST NW
WASHINGTON DC
20036-4910
US

IV. Provider business mailing address

1717 N ST NW STE 1
WASHINGTON DC
20036-2827
US

V. Phone/Fax

Practice location:
  • Phone: 877-949-2005
  • Fax:
Mailing address:
  • Phone: 202-750-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP12073
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number398564
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC200002158
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: