Healthcare Provider Details

I. General information

NPI: 1396778361
Provider Name (Legal Business Name): MCCLENDON CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 N CAPITOL ST NW
WASHINGTON DC
20002-3396
US

IV. Provider business mailing address

1338 N CAPITOL ST NW
WASHINGTON DC
20002-3396
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-0073
  • Fax: 202-379-3478
Mailing address:
  • Phone: 202-745-0073
  • Fax: 202-379-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberB143006
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberB143006
License Number StateDC

VIII. Authorized Official

Name: SANA S RASUL
Title or Position: HR DIRECTOR
Credential:
Phone: 202-745-0073