Healthcare Provider Details

I. General information

NPI: 1598381246
Provider Name (Legal Business Name): WILLIAM MCKINDLEY-WARD LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG50083184
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: