Healthcare Provider Details

I. General information

NPI: 1841627924
Provider Name (Legal Business Name): RICKISHA MONIQUE HERRON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MINNESOTA AVE SE
WASHINGTON DC
20020-5324
US

IV. Provider business mailing address

1001 3RD ST SW APT 216
WASHINGTON DC
20024-4433
US

V. Phone/Fax

Practice location:
  • Phone: 202-671-6240
  • Fax:
Mailing address:
  • Phone: 818-272-9897
  • 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: