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General NPI Number Information
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NPI Number | 1710449772
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Entity Type | Organization
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Legal Business Name | WOODLEY PARK CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 3000 CONNECTICUT AVE NW STE 410
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City | WASHINGTON
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State | DC
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Zip | 20008-2552
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Country | US
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Telephone | 240-481-1892
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Fax |
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Provider Business Mailing Address
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Address Line | 2403 JUMPER LN
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-9037
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Country | US
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Telephone | 240-481-1892
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/THERAPIST
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Name | MRS. AISHA MARIE MARTIN
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Credential | LICSW, LCSW-C
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Telephone | 240-481-1892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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