Healthcare Provider Details

I. General information

NPI: 1356732705
Provider Name (Legal Business Name): DANDELION PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ALBEMARLE ST NW STE 402
WASHINGTON DC
20016-1851
US

IV. Provider business mailing address

4000 ALBEMARLE ST NW STE 402
WASHINGTON DC
20016-1851
US

V. Phone/Fax

Practice location:
  • Phone: 202-531-5385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078381
License Number StateDC

VIII. Authorized Official

Name: ERIKA BUGAJ PETROVA
Title or Position: DIRECTOR/PSYCHOTHERAPIST
Credential: MA, MSW, LICSW
Phone: 202-531-5385