Basic Information
| Provider Information | |||||||||
| NPI: | 1811206188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | TERENCE | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1608 HOBART ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200093705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022368164 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 1ST ST NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200023361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024425885 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2010 | ||||||||
| LastUpdateDate: | 10/04/2010 | ||||||||
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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 | 101YM0800X | LC50078961 | DC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | LC50078961 | DC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.