Organization
CLEAN AND SOBER STREETS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY PRIMES PIERCE III (EXECUTIVE DIRECTOR)
(202) 236-4362
Entity
Organization
Contact information
Practice address
425 2ND ST NW, 2 NORTH, WASHINGTON, DC 20001-2003
(202) 783-7343
(202) 628-1183
Mailing address
PO BOX 77281, WASHINGTON, DC 20013-8281
(202) 236-4362
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
102500R008
DC
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111215-263
DC CERTIFICATION
DC
Enumeration date
03/10/2008
Last updated
05/12/2022
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