Healthcare Provider Details

I. General information

NPI: 1073861498
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 N ST NE
WASHINGTON DC
20002-3324
US

IV. Provider business mailing address

1300 1ST ST NE
WASHINGTON DC
20002-3335
US

V. Phone/Fax

Practice location:
  • Phone: 202-727-8473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC14310
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPRC14310
License Number StateDC

VIII. Authorized Official

Name: JAVON OLIVER
Title or Position: DIRECTOR OF TREATMENT
Credential: LCPC, LPC
Phone: 202-727-8940