Healthcare Provider Details

I. General information

NPI: 1144560509
Provider Name (Legal Business Name): IRENE MENDOZA M.S.,LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE SUITE 240
WASHINGTON DC
20003-4318
US

IV. Provider business mailing address

650 PENNSYLVANIA AVE SE SUITE 240
WASHINGTON DC
20003-4318
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5440
  • Fax:
Mailing address:
  • Phone: 202-544-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC14229
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: