Provider Demographics
NPI:1215474648
Name:VENSON, AGNES REGINA (LPC)
Entity type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:REGINA
Last Name:VENSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:ANGES
Other - Middle Name:REGINA
Other - Last Name:MASON-VENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:3201 ALABAMA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1439
Mailing Address - Country:US
Mailing Address - Phone:301-646-4340
Mailing Address - Fax:
Practice Address - Street 1:3201 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1439
Practice Address - Country:US
Practice Address - Phone:301-646-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACLL1059101YA0400X
DCPRC14177101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health