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General NPI Number Information
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NPI Number | 1740517283
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Entity Type | Organization
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Legal Business Name | EXECUTIVE ADDICTIVE DISEASE PROGRAMS
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 4335 WISCONSIN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20016-2148
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Country | US
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Telephone | 202-362-2588
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Fax | 202-966-4214
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Provider Business Mailing Address
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Address Line | 4335 WISCONSIN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20016-2148
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Country | US
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Telephone | 202-362-2588
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Fax | 202-966-4214
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Authorized Official
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Title or Position | OFFICE MANAGER/FINANCIAL COORDINATO
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Name | MS. AMANDA CARPENTER
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Credential |
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Telephone | 202-362-2588
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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 | PRC948
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | PRC13871
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License Number State | DC
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