Provider Demographics
NPI:1427815836
Name:JUSTICE, XAVIER
Entity type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 STANTON RD SE APT 303
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2256
Mailing Address - Country:US
Mailing Address - Phone:202-270-8525
Mailing Address - Fax:
Practice Address - Street 1:3420 STANTON RD SE APT 303
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2256
Practice Address - Country:US
Practice Address - Phone:202-270-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 101YP1600X, 225400000X, 174H00000X
DC172V00000X, 175T00000X
MD00801-21-A172V00000X
KY284933101YA0400X
MDPR0394175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist