Healthcare Provider Details

I. General information

NPI: 1841837036
Provider Name (Legal Business Name): AFFIRMATIVE SPACES PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 G ST NW STE 800
WASHINGTON DC
20005-6705
US

IV. Provider business mailing address

82 I ST SE APT 1307
WASHINGTON DC
20003-3793
US

V. Phone/Fax

Practice location:
  • Phone: 202-770-7067
  • Fax:
Mailing address:
  • Phone: 678-777-4036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTOINE L. CROSBY
Title or Position: FOUNDER AND CLINICAL DIRECTOR
Credential: PHD
Phone: 202-770-7067