Basic Information
Provider Information | |||||||||
NPI: | 1215385513 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OJO | ||||||||
FirstName: | CARRIE | ||||||||
MiddleName: | MACMILLIN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LICSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SHEPARD | ||||||||
OtherFirstName: | CARRIE | ||||||||
OtherMiddleName: | MACMILLIN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LICSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 60 O ST NW | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200011259 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2027978806 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4 ATLANTIC ST SW | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200322350 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2025409857 | ||||||||
FaxNumber: | 2022328494 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/26/2016 | ||||||||
LastUpdateDate: | 06/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC50080863 | DC | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.