Provider Demographics
NPI:1184947871
Name:P & G COUNSELING AND EDUCATION INSTITUTE
Entity type:Organization
Organization Name:P & G COUNSELING AND EDUCATION INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPY/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,CCDVC,MAC
Authorized Official - Phone:202-526-3880
Mailing Address - Street 1:2218 RHODE ISLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2827
Mailing Address - Country:US
Mailing Address - Phone:202-526-3880
Mailing Address - Fax:202-526-3944
Practice Address - Street 1:2218 RHODE ISLAND NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:202-526-3880
Practice Address - Fax:202-526-3944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:P & G COUNSELING AND EDUCATION INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-09
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC 204101YA0400X
DCPRC204101YP2500X, 103K00000X, 106H00000X, 101YS0200X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC=========Medicaid