Provider Demographics
NPI:1871634170
Name:D.C. DEPARTMENT OF BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:D.C. DEPARTMENT OF BEHAVIORAL HEALTH
Other - Org Name:DC DEPARTMENT OF BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY, COO
Authorized Official - Prefix:
Authorized Official - First Name:RYELLE
Authorized Official - Middle Name:TYVICE
Authorized Official - Last Name:RODDEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-727-9436
Mailing Address - Street 1:64 NEW YORK AVE NE
Mailing Address - Street 2:2ND FLOOR, #228
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3320
Mailing Address - Country:US
Mailing Address - Phone:202-673-2200
Mailing Address - Fax:202-671-3511
Practice Address - Street 1:35 K STREET, N.E.
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4216
Practice Address - Country:US
Practice Address - Phone:202-442-4202
Practice Address - Fax:202-727-0856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-09
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC029869100Medicaid
DC03393900Medicaid
DC09758840Medicaid