Healthcare Provider Details

I. General information

NPI: 1265550578
Provider Name (Legal Business Name): THE MECCA GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 17TH ST NW SUITE 800
WASHINGTON DC
20036-5503
US

IV. Provider business mailing address

1050 17TH ST NW SUITE 800
WASHINGTON DC
20036-5503
US

V. Phone/Fax

Practice location:
  • Phone: 202-529-3117
  • Fax: 202-529-3117
Mailing address:
  • Phone: 202-529-3117
  • Fax: 202-529-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KEISHA L MACK
Title or Position: LICENSED CLINICAL PSYHOLOGIST
Credential: PHD
Phone: 202-529-3117