Healthcare Provider Details

I. General information

NPI: 1508604042
Provider Name (Legal Business Name): EMILY WAHLGREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 CAPITOL CT NE STE 100
WASHINGTON DC
20002-7709
US

IV. Provider business mailing address

1319 S CAPITOL ST SW APT 230
WASHINGTON DC
20003-5209
US

V. Phone/Fax

Practice location:
  • Phone: 610-393-0334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC200001750
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: