Basic Information
| Provider Information | |||||||||
| NPI: | 1851429542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 TAYLOR ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200115617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024649200 | ||||||||
| FaxNumber: | 2024645740 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 TAYLOR ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200115617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024649200 | ||||||||
| FaxNumber: | 2024645740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YA0400X | ADD13838 | DC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 23342 | 01 | DC | CHARTERED (MEDICAID MCO) | OTHER | 5298 | 01 | DC | HEALTHRIGHT(MEDICAID MCO) | OTHER | 287835 | 01 | DC | AMERIGROUP(MEDICAID MCO) | OTHER |