| Paving The Way Multi Service Institute | |
|
2616 Martin Luther King Jr. Avenue Washington DC 20020 | |
| (703) 855-3909 | |
| (703) 521-0731 |
| Full Name | Paving The Way Multi Service Institute |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2616 Martin Luther King Jr. Avenue, Washington, District Of Columbia |
| Authorized Official Name and Position | Paulette Jones (PRESIDENT/CEO) |
| Authorized Official Contact | 7038553909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paving The Way Multi Service Institute 2616 Martin Luther King Jr Ave Se Washington DC 20020-7715 Ph: (703) 855-3909 | Paving The Way Multi Service Institute 2616 Martin Luther King Jr. Avenue Washington DC 20020 Ph: (703) 855-3909 |
| NPI Number | 1407249378 |
|---|---|
| Provider Enumeration Date | 03/16/2015 |
| Last Update Date | 03/16/2015 |
| Medicare PECOS PAC ID | 3476868258 |
|---|---|
| Medicare Enrollment ID | O20150824001081 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407249378 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 400314903242 (District Of Columbia) | Primary |
| Provider Name | Tyrone D Fillyaw |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124285093 PECOS PAC ID: 9133113285 Enrollment ID: I20110209000654 |
| Provider Name | Jermaine A Wyatt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235378258 PECOS PAC ID: 6901080233 Enrollment ID: I20110412000517 |
| Provider Name | Annelle B Primm |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841237252 PECOS PAC ID: 3577879360 Enrollment ID: I20150824001772 |
| Provider Name | Yasmin C Elkhair |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598937849 PECOS PAC ID: 0840500625 Enrollment ID: I20151106000788 |
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