Provider Demographics
NPI:1255666145
Name:OVER THE RAINBOW LLC
Entity Type:Organization
Organization Name:OVER THE RAINBOW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MS NCC LPC
Authorized Official - Phone:540-455-2585
Mailing Address - Street 1:2737 DEVONSHIRE PL NW
Mailing Address - Street 2:UNIT I
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3479
Mailing Address - Country:US
Mailing Address - Phone:540-455-2585
Mailing Address - Fax:
Practice Address - Street 1:2737 DEVONSHIRE PL NW
Practice Address - Street 2:UNIT I
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3479
Practice Address - Country:US
Practice Address - Phone:540-455-2585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13849251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health