1568692002 NPI number — MS. ELIA HEIDIANN CHARLES MSW, LICSW

Table of content: MS. ELIA HEIDIANN CHARLES MSW, LICSW (NPI 1568692002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568692002 NPI number — MS. ELIA HEIDIANN CHARLES MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARLES
Provider First Name:
ELIA
Provider Middle Name:
HEIDIANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568692002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 BRANDYWINE ST SE
Provider Second Line Business Mailing Address:
UNIT 101
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20032-3551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-629-3026
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9080 BEALE RD BLDG 623
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20889-5633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-400-2284
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LC50078580 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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