Provider Demographics
NPI:1598261380
Name:AMACHI FOUNDATION LLC
Entity Type:Organization
Organization Name:AMACHI FOUNDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:PARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GASQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:202-341-3140
Mailing Address - Street 1:9701 APOLLO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4785
Mailing Address - Country:US
Mailing Address - Phone:202-341-3140
Mailing Address - Fax:240-838-3142
Practice Address - Street 1:9701 APOLLO DR STE 100
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4785
Practice Address - Country:US
Practice Address - Phone:202-341-3140
Practice Address - Fax:240-838-3142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty