Provider Demographics
NPI:1952670762
Name:DAVID ANGELICH, PSY. D., PLLC
Entity Type:Organization
Organization Name:DAVID ANGELICH, PSY. D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ANGELICH
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:202-494-6722
Mailing Address - Street 1:4518 S DAKOTA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2752
Mailing Address - Country:US
Mailing Address - Phone:202-494-6722
Mailing Address - Fax:202-248-2466
Practice Address - Street 1:4115 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 203
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2812
Practice Address - Country:US
Practice Address - Phone:202-494-6722
Practice Address - Fax:202-248-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000493261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health