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General NPI Number Information
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NPI Number | 1437415866
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Entity Type | Individual
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Provider Name | CYNTHIA LARDELL JAMISON LPC, LCADC, MAC
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Gender | Female
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 909 43RD PL NE
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City | WASHINGTON
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State | DC
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Zip | 20019-3713
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Country | US
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Telephone | 202-399-1107
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Fax | 202-399-1778
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Provider Business Mailing Address
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Address Line | 6703 JAMES FARMER WAY
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City | CAPITOL HEIGHTS
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State | MD
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Zip | 20743-2150
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Country | US
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Telephone | 301-350-3931
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Fax | 301-324-4808
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCA359
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC16
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License Number State | DC
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