Healthcare Provider Details

I. General information

NPI: 1396920377
Provider Name (Legal Business Name): CENTER FOR STUDENT SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 K ST NW STE 405
WASHINGTON DC
20001-4424
US

IV. Provider business mailing address

1003 K ST NW STE 405
WASHINGTON DC
20001-4424
US

V. Phone/Fax

Practice location:
  • Phone: 202-628-8848
  • Fax:
Mailing address:
  • Phone: 202-628-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL LOUISE VEST
Title or Position: MANAGER OF ADMINISTRATIVE OPERATION
Credential:
Phone: 202-628-8848