Healthcare Provider Details

I. General information

NPI: 1316886054
Provider Name (Legal Business Name): MAPHANTOM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 48TH ST NE
WASHINGTON DC
20019-3668
US

IV. Provider business mailing address

3058 VISTA ST NE
WASHINGTON DC
20018-4010
US

V. Phone/Fax

Practice location:
  • Phone: 202-464-4533
  • Fax: 202-529-0565
Mailing address:
  • Phone: 202-526-1152
  • Fax: 202-529-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. DEMPSEY C HINTON III
Title or Position: OWNER
Credential:
Phone: 202-997-1416