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General NPI Number Information
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NPI Number | 1649851999
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Entity Type | Organization
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Legal Business Name | JADE CLINICAL SERVICES
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 07/15/2023
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Provider Practice Location Address
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Address Line | 62 55TH ST SE
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City | WASHINGTON
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State | DC
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Zip | 20019-6564
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Country | US
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Telephone | 202-596-7162
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Fax |
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Provider Business Mailing Address
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Address Line | 62 55TH ST SE
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City | WASHINGTON
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State | DC
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Zip | 20019-6564
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Country | US
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Telephone | 202-596-7162
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | WHITNEY COLEMAN
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Credential | LICSW
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Telephone | 202-596-7162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 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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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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