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General NPI Number Information
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NPI Number | 1053122978
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Entity Type | Organization
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Legal Business Name | UNITED COUNSELING AND SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 4102 12TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-1809
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Country | US
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Telephone | 202-339-1513
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Fax |
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Provider Business Mailing Address
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Address Line | 9701 APOLLO DR STE 330
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-4795
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Country | US
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Telephone | 240-487-6934
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTINE DOMINIQUE WATKINS
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Credential | LPC
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Telephone | 240-388-1763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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