Healthcare Provider Details

I. General information

NPI: 1174398317
Provider Name (Legal Business Name): ROSE THERAPEUTIC GROUP, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
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

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

V. Phone/Fax

Practice location:
  • Phone: 202-998-6956
  • Fax: 615-658-1388
Mailing address:
  • Phone: 202-998-6956
  • Fax: 615-658-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: CHARLESA PECHE SCOTT
Title or Position: CEO/PROVIDER
Credential: LCSW-C, LICSW
Phone: 202-998-6956