Healthcare Provider Details

I. General information

NPI: 1548585656
Provider Name (Legal Business Name): CHRISTINA TITUS LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CONNECTICUT AVE NW STE 300
WASHINGTON DC
20008-1162
US

IV. Provider business mailing address

4520 FORT TOTTEN DR NE APT 3
WASHINGTON DC
20011-7522
US

V. Phone/Fax

Practice location:
  • Phone: 202-624-0010
  • Fax:
Mailing address:
  • Phone: 202-248-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG50079128
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: