Provider Demographics
NPI:1265550578
Name:THE MECCA GROUP
Entity type:Organization
Organization Name:THE MECCA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-529-3117
Mailing Address - Street 1:1050 17TH ST NW
Mailing Address - Street 2:SUITE 800
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5503
Mailing Address - Country:US
Mailing Address - Phone:202-529-3117
Mailing Address - Fax:202-529-3117
Practice Address - Street 1:1050 17TH ST NW
Practice Address - Street 2:SUITE 800
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5503
Practice Address - Country:US
Practice Address - Phone:202-529-3117
Practice Address - Fax:202-529-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty