Healthcare Provider Details

I. General information

NPI: 1821344565
Provider Name (Legal Business Name): DISTRICT THERAPEUTICS AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONNECTICUT AVE NW SUITE 825
WASHINGTON DC
20036-1722
US

IV. Provider business mailing address

1350 CONNECTICUT AVE NW SUITE 825
WASHINGTON DC
20036-1722
US

V. Phone/Fax

Practice location:
  • Phone: 202-986-5941
  • Fax:
Mailing address:
  • Phone: 202-986-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY1000347
License Number StateDC

VIII. Authorized Official

Name: DR. BRADLEY R BRENNER
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 202-986-5941