Healthcare Provider Details

I. General information

NPI: 1265812580
Provider Name (Legal Business Name): BETTY ANN PALMORE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-3718
US

IV. Provider business mailing address

1427 SHIPPEN LN SE
WASHINGTON DC
20020-2902
US

V. Phone/Fax

Practice location:
  • Phone: 202-581-0490
  • Fax: 202-581-0495
Mailing address:
  • Phone: 202-730-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC514
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: