Provider Demographics
NPI:1205167038
Name:SWEENEY, MARK TIMOTHY (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:TIMOTHY
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 WALTER ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1449
Mailing Address - Country:US
Mailing Address - Phone:202-596-5951
Mailing Address - Fax:866-712-1080
Practice Address - Street 1:1253 WALTER ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1449
Practice Address - Country:US
Practice Address - Phone:202-596-5951
Practice Address - Fax:866-712-1080
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional