Individual
KEVIN TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4660 MARTIN LUTHER KING JR AVE SW, WASHINGTON, DC 20032-4933
(202) 318-0179
Mailing address
1310 GALLATIN ST NW, WASHINGTON, DC 20011-6918
(202) 621-4239
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/31/2023
Last updated
06/14/2023
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