Healthcare Provider Details

I. General information

NPI: 1205341260
Provider Name (Legal Business Name): STEPHANIE PRYMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 21ST ST NW
WASHINGTON DC
20052
US

IV. Provider business mailing address

738 9TH ST SE
WASHINGTON DC
20003-2804
US

V. Phone/Fax

Practice location:
  • Phone: 202-994-2486
  • Fax:
Mailing address:
  • Phone: 410-707-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC15167
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: