MEDICARE: BEZAWIT ADDIS

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	LGPC00514	DC

General Provider Information

NPI Number	:	1972060671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEZAWIT ADDIS

Provider Business Mailing Address
First Line	:	2000 P ST NW STE 410
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-6922
Country	:	US
Telephone Number	:	202-644-8904
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 P ST NW STE 200
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-6924
Country	:	US
Telephone Number	:	202-644-8904
Fax Number	:

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

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	03/30/2020

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Directions to “ BEZAWIT ADDIS ” Practice Location

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