Provider Demographics
NPI:1295292944
Name:D.C. DEPARTMENT OF BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:D.C. DEPARTMENT OF BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID ELIGIBILITY COMP. OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAMISHA
Authorized Official - Middle Name:NICOLE KELLY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-671-3206
Mailing Address - Street 1:64 NEW YORK AVE NE FL E2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3320
Mailing Address - Country:US
Mailing Address - Phone:202-671-3206
Mailing Address - Fax:
Practice Address - Street 1:35 K ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4216
Practice Address - Country:US
Practice Address - Phone:202-671-3206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOVERNMENT OF THE DISTRICT OF COLUMBIA OFFICE OF TAX AND REVENUE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy