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General NPI Number Information
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NPI Number | 1245808666
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Entity Type | Organization
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Legal Business Name | ICON CLINIC LLC
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Dates
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Enumeration Date | 06/13/2021
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 2000 RHODE ISLAND AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20018-2835
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Country | US
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Telephone | 240-455-3166
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Fax | 240-455-4154
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Provider Business Mailing Address
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Address Line | 7735 BELLE POINT DR
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City | GREENBELT
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State | MD
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Zip | 20770-3300
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Country | US
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Telephone | 240-455-3166
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Fax | 240-455-4154
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Authorized Official
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Title or Position | PROVIDER/CEO
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Name | MR. THICKNESS PATRICK EGWUATU
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Credential | BC-PMHNP
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Telephone | 202-288-7752
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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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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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