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General NPI Number Information
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NPI Number | 1801513304
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Entity Type | Individual
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Provider Name | LUCY CLARKE BRINCKERHOFF CAC I
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Gender | Female
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 4430 BENNING RD NE
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City | WASHINGTON
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State | DC
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Zip | 20019-4555
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Country | US
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Telephone | 202-388-4935
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Fax |
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Provider Business Mailing Address
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Address Line | 3707 WOODLEY RD NW APT 41
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City | WASHINGTON
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State | DC
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Zip | 20016-5061
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Country | US
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Telephone | 202-999-0845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CACI20000006
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License Number State | DC
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