Healthcare Provider Details

I. General information

NPI: 1689558090
Provider Name (Legal Business Name): ANNA SUMMER WAMAITHA IRUNGU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 WISCONSIN AVE NW STE 300
WASHINGTON DC
20016-4606
US

IV. Provider business mailing address

6200 WESTCHESTER PARK DR APT 1617
COLLEGE PARK MD
20740-2842
US

V. Phone/Fax

Practice location:
  • Phone: 504-250-4819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC200012505
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: