Healthcare Provider Details

I. General information

NPI: 1841120656
Provider Name (Legal Business Name): CLINTON TAMI ACHA HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 W FOREST RD
HYATTSVILLE MD
20785-1753
US

IV. Provider business mailing address

6608 W FOREST RD
HYATTSVILLE MD
20785-1753
US

V. Phone/Fax

Practice location:
  • Phone: 202-430-8068
  • Fax:
Mailing address:
  • Phone: 202-430-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberHHA200006173
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: