Healthcare Provider Details

I. General information

NPI: 1598261380
Provider Name (Legal Business Name): AMACHI FOUNDATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DR STE 100
LARGO MD
20774-4785
US

IV. Provider business mailing address

9701 APOLLO DR STE 100
LARGO MD
20774-4785
US

V. Phone/Fax

Practice location:
  • Phone: 202-341-3140
  • Fax: 240-838-3142
Mailing address:
  • Phone: 202-341-3140
  • Fax: 240-838-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PARIS GASQUE
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 202-341-3140