Provider Demographics
NPI:1255711511
Name:LOVELACE, TAIWAN (PHD)
Entity type:Individual
Prefix:DR
First Name:TAIWAN
Middle Name:
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 HOWARD RD SE
Mailing Address - Street 2:SECOND FLOOR SMHP
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5805
Mailing Address - Country:US
Mailing Address - Phone:202-834-2636
Mailing Address - Fax:
Practice Address - Street 1:725 19TH ST NE
Practice Address - Street 2:FRIENDSHIP PUBLIC CHARTER SCHOOL-BLOW PIERCE ACADEMY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4713
Practice Address - Country:US
Practice Address - Phone:202-834-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYA00042103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist