Basic Information
| Provider Information | |||||||||
| NPI: | 1710177704 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAPIN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D., LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | WRAMC BLDG 2, ROOM 2J38 | ||||||||
| Address2: | 6900 GEORGIA AVE. NW | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027827250 | ||||||||
| FaxNumber: | 2027824922 | ||||||||
| Practice Location | |||||||||
| Address1: | WRAMC BLDG 2, DEPARTMENT OF SOCIAL WORK | ||||||||
| Address2: | 6900 GEORGIA AVE. NW | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027826378 | ||||||||
| FaxNumber: | 2027824922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I-7114 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | I-7114 | 01 | OH | STATE OF OHIO COUNSELOR, | OTHER |