Provider Demographics
NPI:1437296571
Name:THERAPEUTIC TRANSITIONS, INC.
Entity Type:Organization
Organization Name:THERAPEUTIC TRANSITIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORLIS
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-397-5042
Mailing Address - Street 1:823 12TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4462
Mailing Address - Country:US
Mailing Address - Phone:202-397-5042
Mailing Address - Fax:202-397-1684
Practice Address - Street 1:823 12TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4462
Practice Address - Country:US
Practice Address - Phone:202-397-5042
Practice Address - Fax:101-397-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC301584261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC117892OtherAMERIGROUP
DC21727OtherCHARTERED HEALTH
DC21726OtherCHARTERED HEALTH - JOHNSO