Provider Demographics
NPI:1780015347
Name:GORODETSKY, ALEXANDER (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:GORODETSKY
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 PENNSYLVANIA AVENUE NW
Mailing Address - Street 2:SUITE 602
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006
Mailing Address - Country:US
Mailing Address - Phone:301-758-6562
Mailing Address - Fax:
Practice Address - Street 1:1901 PENNSYLVANIA AVENUE NW
Practice Address - Street 2:SUITE 602
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:301-758-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional