Healthcare Provider Details

I. General information

NPI: 1457808909
Provider Name (Legal Business Name): KASVU COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONNECTICUT AVE NW STE 612
WASHINGTON DC
20036-1735
US

IV. Provider business mailing address

1350 CONNECTICUT AVE NW STE 612
WASHINGTON DC
20036-1735
US

V. Phone/Fax

Practice location:
  • Phone: 202-656-0258
  • Fax:
Mailing address:
  • Phone: 202-656-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1001024
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1001024
License Number StateDC

VIII. Authorized Official

Name: DAVIN MAIJALA
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSYD
Phone: 202-656-0258