Organization
THERAPEUTIC TRANSITIONS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORLIS YVONNE RANDOLPH PH.D. (ADMINISTRATOR)
(202) 397-5042
Entity
Organization
Contact information
Practice address
823 12TH ST NE, WASHINGTON, DC 20002-4462
(202) 397-5042
(101) 397-1684
Mailing address
823 12TH ST NE, WASHINGTON, DC 20002-4462
(202) 397-5042
(202) 397-1684
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
LC301584
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117892
AMERIGROUP
DC
01
—
21726
CHARTERED HEALTH - JOHNSO
DC
01
—
21727
CHARTERED HEALTH
DC
Enumeration date
01/30/2007
Last updated
08/22/2020
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