Healthcare Provider Details

I. General information

NPI: 1194154740
Provider Name (Legal Business Name): DEBRA MITCHELL-CHISELOM M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST ST NE FL 9
WASHINGTON DC
20002-7953
US

IV. Provider business mailing address

1200 1ST ST NE FL 9
WASHINGTON DC
20002-7953
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-6870
  • Fax:
Mailing address:
  • Phone: 202-388-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: