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General NPI Number Information
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NPI Number | 1366776981
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Entity Type | Organization
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Legal Business Name | WASHINGTON INTERNATIONAL CENTER FOR CREATIVITY, PLLC
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 5335 WISCONSIN AVE NW STE 440
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City | WASHINGTON
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State | DC
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Zip | 20015-2054
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Country | US
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Telephone | 202-243-0595
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Fax | 202-243-0596
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Provider Business Mailing Address
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Address Line | 5335 WISCONSIN AVE NW STE 440
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City | WASHINGTON
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State | DC
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Zip | 20015-2054
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Country | US
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Telephone | 202-243-0595
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Fax | 202-243-0596
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROSA AURORA CHAVEZ-EAKLE
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Credential | PH.D., LPC, NCC
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Telephone | 202-243-0595
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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 | PRC14033
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License Number State | DC
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