Provider Demographics
NPI:1710449772
Name:WOODLEY PARK CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:WOODLEY PARK CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW-C
Authorized Official - Phone:240-481-1892
Mailing Address - Street 1:2403 JUMPER LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9037
Mailing Address - Country:US
Mailing Address - Phone:240-481-1892
Mailing Address - Fax:
Practice Address - Street 1:3000 CONNECTICUT AVE NW STE 410
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2552
Practice Address - Country:US
Practice Address - Phone:240-481-1892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty