Healthcare Provider Details

I. General information

NPI: 1568829497
Provider Name (Legal Business Name): NITIKA KUMAR GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 07/09/2022
Certification Date: 07/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

1651 LAMONT ST NW APT 2E
WASHINGTON DC
20010-2705
US

V. Phone/Fax

Practice location:
  • Phone: 202-235-4997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008415
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: