Healthcare Provider Details

I. General information

NPI: 1306009402
Provider Name (Legal Business Name): MRS. VERNESSA L DICKENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 LENFANT SQ SE
WASHINGTON DC
20020-6724
US

IV. Provider business mailing address

1301 LENFANT SQ SE
WASHINGTON DC
20020-6724
US

V. Phone/Fax

Practice location:
  • Phone: 202-584-1244
  • Fax: 202-584-1249
Mailing address:
  • Phone: 202-584-1244
  • Fax: 202-584-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC302143
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: