Basic Information
| Provider Information | |||||||||
| NPI: | 1912643321 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNICORN HEALTH CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 PENNSYLVANIA AVE SE | ||||||||
| Address2: | STE 410 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200034339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035171947 | ||||||||
| FaxNumber: | 2025443004 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 PENNSYLVANIA AVE SE | ||||||||
| Address2: | STE 410 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200034339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035171947 | ||||||||
| FaxNumber: | 2025443004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2022 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | RICE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS SYSTEMS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2026741227 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.