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General NPI Number Information
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NPI Number | 1831577501
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Entity Type | Organization
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Legal Business Name | KNOWLEDGE OF SELF THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 1629 K ST NW SUITE 300
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City | WASHINGTON
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State | DC
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Zip | 20006-1602
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Country | US
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Telephone | 202-885-5798
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 IVY CLUB LN UNIT 342
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City | LANDOVER
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State | MD
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Zip | 20785-4513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | MARKISHA BENNETT
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Credential | PSY.D.
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Telephone | 954-681-0669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY1000740
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License Number State | DC
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