Provider First Line Business Practice Location Address: 
35 K STREET, 2ND FLOOR
    Provider Second Line Business Practice Location Address: 
MENTAL HEALTH SERVICES DIVISION
    Provider Business Practice Location Address City Name: 
WASHINGTON
    Provider Business Practice Location Address State Name: 
DC
    Provider Business Practice Location Address Postal Code: 
20002
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
202-442-4873
    Provider Business Practice Location Address Fax Number: 
202-727-0857
    Provider Enumeration Date: 
09/16/2015