Healthcare Provider Details

I. General information

NPI: 1942578133
Provider Name (Legal Business Name): PSI SERVICES III, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 DIX ST NE
WASHINGTON DC
20019-6965
US

IV. Provider business mailing address

8301 PROFESSIONAL PL STE 205
HYATTSVILLE MD
20785-2353
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-3870
  • Fax:
Mailing address:
  • Phone: 301-552-7120
  • Fax: 301-654-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SHAWN RUBBIN
Title or Position: CHIEF ADVANCEMENT OFFICER
Credential:
Phone: 301-552-7120