Healthcare Provider Details

I. General information

NPI: 1235885096
Provider Name (Legal Business Name): GOTEL & THRIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E ST SE STE 300
WASHINGTON DC
20003-2620
US

IV. Provider business mailing address

4400 LEE ST NE
WASHINGTON DC
20019-3833
US

V. Phone/Fax

Practice location:
  • Phone: 202-430-5461
  • Fax:
Mailing address:
  • Phone: 202-615-0965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS L GOTEL
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LICSW, RPT-S
Phone: 202-430-5461