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General NPI Number Information
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NPI Number | 1801279393
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Entity Type | Organization
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Legal Business Name | WISCONSIN AVE PSYCHIATRIC CENTER INC
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 4228 WISCONSIN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20016-2138
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Country | US
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Telephone | 202-885-5600
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Fax | 202-885-5842
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Provider Business Mailing Address
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Address Line | 4228 WISCONSIN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20016-2138
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Country | US
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Telephone | 202-885-5600
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Fax | 202-885-5842
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Authorized Official
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Title or Position | CEO
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Name | MR. CHARLES J BAUMGARDNER
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Credential |
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Telephone | 202-885-5600
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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 | HFD01-0011
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License Number State | DC
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Taxonomy #2
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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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