Healthcare Provider Details

I. General information

NPI: 1235597527
Provider Name (Legal Business Name): D.C. DEPARTMENT OF BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 NEW YORK AVE NE 1ST FLOOR - P STREET ENTRANCE
WASHINGTON DC
20002-3320
US

IV. Provider business mailing address

64 NEW YORK AVE NE 3RD FLOOR
WASHINGTON DC
20002-3320
US

V. Phone/Fax

Practice location:
  • Phone: 202-727-8857
  • Fax:
Mailing address:
  • Phone: 202-727-8857
  • Fax: 202-727-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARQUITTA L DUVERNAY
Title or Position: INTERIM DEPUTY DIRECTOR
Credential: D.H.A., LCPC
Phone: 202-727-8941