Organization
PROVIDENCE HEALTH SERVICES, INC
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
PHS Outpatient Behavioral Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HOSPITAL
Authorized official
MITCHELL LOMAX (VICE PRESIDENT/CFO)
(667) 234-2926
Entity
Organization
Contact information
Practice address
1140 VARNUM ST NE STE 100, WASHINGTON, DC 20017
(202) 854-7623
(202) 854-7616
Mailing address
1150 VARNUM ST NE, ST CATHERINES HALL 102, WASHINGTON, DC 20017-2180
(202) 854-4069
(202) 269-7825
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
HFD01-0212
DC
103T00000X
Psychologist
HFD01-0212
DC
104100000X
Social Worker
HFD01-0212
DC
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
HFD01-0212
DC
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
HFD01-0212
DC
2084N0400X
Neurology Physician
Primary
HFD01-0212
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
985415100
—
MD
Enumeration date
07/18/2008
Last updated
10/20/2023
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