Healthcare Provider Details

I. General information

NPI: 1982259594
Provider Name (Legal Business Name): HUMAN THEORY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E ST NW APT A416
WASHINGTON DC
20037-2806
US

IV. Provider business mailing address

2301 E ST NW APT A416
WASHINGTON DC
20037-2806
US

V. Phone/Fax

Practice location:
  • Phone: 303-513-3391
  • Fax:
Mailing address:
  • Phone: 303-513-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN GASPER JACQUES
Title or Position: OWNER
Credential: LPC
Phone: 303-513-3391