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General NPI Number Information
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NPI Number | 1497308191
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Entity Type | Organization
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Legal Business Name | WISDOM ONE LLC
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 7603 GEORGIA AVE NW STE 202
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City | WASHINGTON
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State | DC
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Zip | 20012-1617
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Country | US
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Telephone | 202-836-4859
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Fax | 202-291-2249
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Provider Business Mailing Address
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Address Line | 7603 GEORGIA AVE NW STE 202
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City | WASHINGTON
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State | DC
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Zip | 20012-1617
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Country | US
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Telephone | 28-364-8592
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHARLES TEKEH
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Credential | BSC
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Telephone | 202-836-4859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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