Provider Demographics
NPI:1699103622
Name:DCPS
Entity type:Organization
Organization Name:DCPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:202-673-7385
Mailing Address - Street 1:5504 TROUT RUN RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1568
Mailing Address - Country:US
Mailing Address - Phone:202-673-7385
Mailing Address - Fax:
Practice Address - Street 1:5504 TROUT RUN RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735
Practice Address - Country:US
Practice Address - Phone:202-673-7385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50078138104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCLG50078138Medicaid