Provider Demographics
NPI:1710248406
Name:HIPOL, CHARRISE (PSYD)
Entity Type:Individual
Prefix:
First Name:CHARRISE
Middle Name:
Last Name:HIPOL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 MASSACHUSETTS AVE NW
Mailing Address - Street 2:MARY GRAYDON 214
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-8001
Mailing Address - Country:US
Mailing Address - Phone:720-254-5080
Mailing Address - Fax:
Practice Address - Street 1:4400 MASSACHUSETTS AVE NW
Practice Address - Street 2:MARY GRAYDON 214
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-8001
Practice Address - Country:US
Practice Address - Phone:720-254-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000695103TC0700X
VA0810004334103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical