Healthcare Provider Details

I. General information

NPI: 1144910944
Provider Name (Legal Business Name): AMANDA ALEXIS KOBA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

611 PENNSYLVANIA AVE SE # 415
WASHINGTON DC
20003-4303
US

V. Phone/Fax

Practice location:
  • Phone: 202-709-3930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG200001335
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: