Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 103K00000X | Behavior Analyst | | | | No |
| 2 | 103T00000X | Psychologist | | | | No |
| 3 | 103TC1900X | Psychologist | Counseling | | | No |
| 4 | 251E00000X | Home Health | | | | No |
| 5 | 251S00000X | Community/Behavioral Health | | | | No |
| 6 | 261QD1600X | Clinic/Center | Developmental Disabilities | | | No |
| 7 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 8 | 261QM0850X | Clinic/Center | Adult Mental Health | | | No |
| 9 | 261QM2800X | Clinic/Center | Methadone | | | No |
| 10 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | | | No |
| 11 | 291U00000X | Clinical Medical Laboratory | | | | No |
| 12 | 3245S0500X | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | | | No |
| 13 | 101YM0800X | Counselor | Mental Health | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 063172881 | MEDICAID | DISTRICT OF COLUMBIA | |
