Provider Demographics
NPI:1265765820
Name:PSYCHOLOGICAL GROUP OF WASHINGTON
Entity type:Organization
Organization Name:PSYCHOLOGICAL GROUP OF WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN KING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-223-9844
Mailing Address - Street 1:2141 K ST NW
Mailing Address - Street 2:605
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1810
Mailing Address - Country:US
Mailing Address - Phone:202-223-9844
Mailing Address - Fax:
Practice Address - Street 1:2141 K ST NW
Practice Address - Street 2:605
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1810
Practice Address - Country:US
Practice Address - Phone:202-223-9844
Practice Address - Fax:202-223-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13940101YP2500X
DCPSY1000460103TC0700X
DCPSY1000438103TC0700X
DCPSY1000307103TC0700X
DCPSY1672103TC1900X
DCPSY1000434103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty