MEDICARE: CHIDIOMIMI CHIME LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC15035	MD
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1902419740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIDIOMIMI CHIME LCPC

Provider Business Mailing Address
First Line	:	50 SEEK CT
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-7234
Country	:	US
Telephone Number	:	202-321-9953
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 SEEK CT
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-7234
Country	:	US
Telephone Number	:	202-423-1631
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2020
Last Update Date	:	07/29/2024

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Directions to “ CHIDIOMIMI CHIME LCPC” Practice Location

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