Provider Demographics
NPI:1033448428
Name:CAPITOL REGION CHILDREN'S CENTER
Entity Type:Organization
Organization Name:CAPITOL REGION CHILDREN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:EVANGELOU
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW, MSW
Authorized Official - Phone:301-806-4325
Mailing Address - Street 1:PO BOX 15828
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20825-5828
Mailing Address - Country:US
Mailing Address - Phone:202-596-5951
Mailing Address - Fax:866-712-1080
Practice Address - Street 1:1253 WALTER ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1449
Practice Address - Country:US
Practice Address - Phone:202-596-5951
Practice Address - Fax:866-712-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50078775251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management