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Individual

MR. TUBARUS CHISHOLM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
2200 PENNSYLVANIA AVE NW, WASHINGTON, DC 20037-1709
(202) 441-0842
Mailing address
PO BOX 15765, WASHINGTON, DC 20003-0765
(202) 441-0842

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LC3626
MD
101YP2500X
Professional Counselor
Primary
PRC14348
DC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
LC3626
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
MD
01
PRC14348
DEPARTMENT OF HEALTH LICENSING
DC
Enumeration date
10/17/2014
Last updated
10/18/2015
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