Healthcare Provider Details

I. General information

NPI: 1124610381
Provider Name (Legal Business Name): ALICIA R JEMISON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 5TH ST NW
WASHINGTON DC
20011-1325
US

IV. Provider business mailing address

6315 5TH ST NW
WASHINGTON DC
20011-1325
US

V. Phone/Fax

Practice location:
  • Phone: 202-671-6080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC200003887
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: