Healthcare Provider Details

I. General information

NPI: 1184149676
Provider Name (Legal Business Name): ACHIEVING MENTAL VICTORY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 HOLLY LN
CLINTON MD
20735-3195
US

IV. Provider business mailing address

8110 HOLLY LN
CLINTON MD
20735-3195
US

V. Phone/Fax

Practice location:
  • Phone: 202-503-6429
  • Fax: 202-503-6429
Mailing address:
  • Phone: 202-503-6429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. APRIL VICTORIA MARTIN
Title or Position: OWNER
Credential:
Phone: 202-503-6429