| NPI | 1821648312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES FONGE Director 202-361-8012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2020-09-10 |