Healthcare Provider Details

I. General information

NPI: 1609776343
Provider Name (Legal Business Name): KETURAH STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2026
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 44TH ST NE
WASHINGTON DC
20019-1915
US

IV. Provider business mailing address

504 1/2 E ST NE
WASHINGTON DC
20002-5214
US

V. Phone/Fax

Practice location:
  • Phone: 202-671-6020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC200005062
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: