=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932925765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOOSING CLARITY THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2024
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1822 41ST PL SE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20020-6022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-584-6314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1822 41ST PL SE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20020-6022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-584-6314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MELISSA LAURA HERENDEEN
-----------------------------------------------------
Credential | LCSW-C
-----------------------------------------------------
Telephone | 443-584-6314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------