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General NPI Number Information
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NPI Number | 1760503197
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Entity Type | Organization
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Legal Business Name | PUBLIC CHARTER SCHOOL CENTER FOR STUDENT SUPPORT SERVICES
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1003 K ST NW SUITE 405
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City | WASHINGTON
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State | DC
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Zip | 20001-4425
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Country | US
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Telephone | 202-628-8848
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Fax | 202-628-8849
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Provider Business Mailing Address
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Address Line | 1003 K ST NW SUITE 405
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City | WASHINGTON
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State | DC
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Zip | 20001-4425
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Country | US
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Telephone | 202-628-8848
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Fax | 202-628-8849
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CAROLYN L GARDNER II
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Credential |
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Telephone | 202-628-8848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 036394400
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License Number State | DC
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