=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346395860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHC OUTPATIENT BEHAVIORAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 216 MICHIGAN AVE NE TRINITY SQUARE SECOND FLOOR
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20017-1095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-877-6552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4414 UNDERWOOD ST
-----------------------------------------------------
City | UNIVERSITY PARK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20782-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-877-6552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. DESI GRIFFIN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 202-877-6464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | LC50078028
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------