Healthcare Provider Details

I. General information

NPI: 1689018368
Provider Name (Legal Business Name): THE PEOPLE'S CHOICE BEHAVIORAL & HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 MINNESOTA AVE SE
WASHINGTON DC
20019-1127
US

IV. Provider business mailing address

2918 MINNESOTA AVE SE
WASHINGTON DC
20019-1127
US

V. Phone/Fax

Practice location:
  • Phone: 202-629-2964
  • Fax: 877-735-1149
Mailing address:
  • Phone: 202-629-2964
  • Fax: 877-735-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY1835
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY1835
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY1835
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1835
License Number StateDC

VIII. Authorized Official

Name: OMETHA O LEWIS-JACK
Title or Position: CHIEF CLINICAL DIRECTOR
Credential: PHD
Phone: 202-629-2964