Provider Demographics
NPI:1285978080
Name:NATIONAL COLLEGIATE PREPARATORY PCHS
Entity type:Organization
Organization Name:NATIONAL COLLEGIATE PREPARATORY PCHS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-832-7737
Mailing Address - Street 1:4600 LIVINGSTON RD SE
Mailing Address - Street 2:NATIONAL COLLEGIATE PREPARTORY PCHS
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4098
Mailing Address - Country:US
Mailing Address - Phone:202-832-7737
Mailing Address - Fax:202-832-7736
Practice Address - Street 1:4600 LIVINGSTON RD SE
Practice Address - Street 2:NATIONAL COLLEGIATE PREPARTORY PCHS
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4098
Practice Address - Country:US
Practice Address - Phone:202-832-7737
Practice Address - Fax:202-832-7736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14026101YP2500X
DCPSY1000323103T00000X
DCLC500783301041S0200X
DCSLP000442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty