Healthcare Provider Details

I. General information

NPI: 1629858865
Provider Name (Legal Business Name): AZALECH N/A TEGENE LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 NEW YORK AVE NE FL 3
WASHINGTON DC
20002-3328
US

IV. Provider business mailing address

1905 E ST SE # 14
WASHINGTON DC
20003-2593
US

V. Phone/Fax

Practice location:
  • Phone: 202-673-9120
  • Fax:
Mailing address:
  • Phone: 202-673-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG2000004706
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: