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General NPI Number Information
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NPI Number | 1386786093
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE LIFE CENTER INC.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1933 MONTANA AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20002-1817
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Country | US
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Telephone | 202-842-2016
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Fax | 202-842-0604
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Provider Business Mailing Address
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Address Line | 1704 17TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-1810
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Country | US
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Telephone | 202-842-2016
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Fax | 202-842-0604
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Authorized Official
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Title or Position | DIRECTOR OF QI AND BHC
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Name | DR. TRACY OZZALINE GARRETT
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Credential | PH.D.
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Telephone | 202-842-2016
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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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