Provider Demographics
NPI:1457138190
Name:EWING, CHARISSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARISSE
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22664 THREE NOTCH RD UNIT 130
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-2154
Mailing Address - Country:US
Mailing Address - Phone:202-316-2512
Mailing Address - Fax:
Practice Address - Street 1:22664 THREE NOTCH RD UNIT 130
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-2154
Practice Address - Country:US
Practice Address - Phone:202-316-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool