Healthcare Provider Details

I. General information

NPI: 1356660922
Provider Name (Legal Business Name): CARL LEE ALGOOD MSW LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

7054 EASTERN AVE NW APT 204
WASHINGTON DC
20012-2042
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-3277
  • Fax:
Mailing address:
  • Phone: 202-545-0213
  • Fax: 202-545-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC300530
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: