Healthcare Provider Details

I. General information

NPI: 1770710014
Provider Name (Legal Business Name): THE LAB SCHOOL OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2009
Last Update Date: 06/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4759 RESERVOIR RD NW
WASHINGTON DC
20007-1921
US

IV. Provider business mailing address

4759 RESERVOIR RD NW
WASHINGTON DC
20007-1921
US

V. Phone/Fax

Practice location:
  • Phone: 202-454-2242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1680
License Number StateDC

VIII. Authorized Official

Name: DR. LUANNE ADAMS
Title or Position: DIRECTOR, PSYCHOLOGICAL SERVICES
Credential: PH.D.
Phone: 202-965-6600