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General NPI Number Information
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NPI Number | 1518396100
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Entity Type | Organization
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Legal Business Name | WASHINGTON ADVENTIST UNIVERSITY COMMUNITY COUNSELING CENTER
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 7600 FLOWER AVE SUITE 441-PSYCHOLOGY DEPARTMENT
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City | TAKOMA PARK
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State | MD
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Zip | 20912-7744
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Country | US
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Telephone | 301-576-0131
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Fax | 301-891-4054
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Provider Business Mailing Address
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Address Line | 7600 FLOWER AVE SUITE 441-PSYCHOLOGY DEPARTMENT
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City | TAKOMA PARK
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State | MD
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Zip | 20912-7744
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Country | US
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Telephone | 301-576-0131
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Fax | 301-891-4054
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | MS. JUDITH ANN UPSHAW
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Credential | LCADC, ABD
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Telephone | 301-576-0131
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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 | LCA393
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License Number State | MD
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