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General NPI Number Information
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NPI Number | 1346917432
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Entity Type | Individual
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Provider Name | DAVYNTE PANNELL
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Gender | Male
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 915 RHODE ISLAND AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20001-4153
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Country | US
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Telephone | 301-848-9608
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20380
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City | NEWARK
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State | NJ
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Zip | 07101-6380
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC200001572
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00509500
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License Number State | NJ
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