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General NPI Number Information
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NPI Number | 1396935086
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Entity Type | Organization
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Legal Business Name | CRISIS MANAGEMENT INTROSPECT
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Dates
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Enumeration Date | 07/28/2007
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 2314 MINNESOTA AVE SE WASHINGTON, DC
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City | WASHINGTON
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State | DC
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Zip | 20020-5326
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Country | US
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Telephone | 202-581-0778
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Fax | 202-581-0778
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Provider Business Mailing Address
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Address Line | 2314 MINNESOTA AVE SE WASHINGTON, DC
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City | WASHINGTON
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State | DC
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Zip | 20020-5326
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Country | US
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Telephone | 202-581-0778
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Fax | 202-581-0778
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CAROLYN ELAINE GRAVELY-MOSS,PH.D.
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Credential | PH.D
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Telephone | 202-581-0778
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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 | LPC-0164
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License Number State | DC
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