Healthcare Provider Details

I. General information

NPI: 1205167038
Provider Name (Legal Business Name): MARK TIMOTHY SWEENEY PH.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 WALTER ST SE
WASHINGTON DC
20003-1449
US

IV. Provider business mailing address

1253 WALTER ST SE
WASHINGTON DC
20003-1449
US

V. Phone/Fax

Practice location:
  • Phone: 202-596-5951
  • Fax: 866-712-1080
Mailing address:
  • Phone: 202-596-5951
  • Fax: 866-712-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC13878
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: