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General NPI Number Information
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NPI Number | 1619859675
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Entity Type | Organization
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Legal Business Name | HERISE GROWTH CENTER
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 4905 SHERIFF RD NE
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City | WASHINGTON
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State | DC
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Zip | 20019-4802
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Country | US
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Telephone | 202-617-1006
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Fax |
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Provider Business Mailing Address
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Address Line | 6218 GEORGIA AVE NW STE 1-653
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City | WASHINGTON
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State | DC
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Zip | 20011-5125
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Country | US
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Telephone | 202-617-1006
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | ANDRANE M GORDON
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Credential |
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Telephone | 202-617-1006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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