Healthcare Provider Details

I. General information

NPI: 1174096648
Provider Name (Legal Business Name): EMILY ROSE REMILLARD LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 M ST SE
WASHINGTON DC
20003-3609
US

IV. Provider business mailing address

636 MASSACHUSETTS AVE NE
WASHINGTON DC
20002-6006
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-3870
  • Fax:
Mailing address:
  • Phone: 907-854-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP8846
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC00394
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: