Healthcare Provider Details

I. General information

NPI: 1114734027
Provider Name (Legal Business Name): 5615 WOODLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 FIRST STREET, NW #2
WASHINGTON DC
20011
US

IV. Provider business mailing address

5615 FIRST STREET, NW #2
WASHINGTON DC
20011
US

V. Phone/Fax

Practice location:
  • Phone: 202-991-1631
  • Fax:
Mailing address:
  • Phone: 202-991-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA CABRERA
Title or Position: EXECUTIVE DIRECTOR
Credential: LICSW
Phone: 202-991-1631