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General NPI Number Information
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NPI Number | 1619223633
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Entity Type | Organization
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Legal Business Name | THE ELIZABETH MINISTRY (TEM)
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 200 55TH ST NE # 210
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City | WASHINGTON
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State | DC
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Zip | 20019-6783
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Country | US
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Telephone | 202-388-3506
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Fax | 202-388-3506
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Provider Business Mailing Address
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Address Line | 200 55TH ST NE # 210
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City | WASHINGTON
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State | DC
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Zip | 20019-6783
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Country | US
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Telephone | 202-388-3506
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Fax | 202-388-3506
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Authorized Official
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Title or Position | BOARD PRESENT
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Name | DR. CAROLYN NADENE GRAHAM
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Credential | PHD
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Telephone | 202-388-3506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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