Provider Demographics
NPI:1306304563
Name:DC MULTICULTURAL COUNSELING CENTER LLC
Entity type:Organization
Organization Name:DC MULTICULTURAL COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DOHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIBANI TALAAT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-615-1563
Mailing Address - Street 1:15715 KRUHM RD
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1409
Mailing Address - Country:US
Mailing Address - Phone:301-615-1563
Mailing Address - Fax:
Practice Address - Street 1:15715 KRUHM RD
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1409
Practice Address - Country:US
Practice Address - Phone:301-615-1563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD070357500Medicaid