Healthcare Provider Details

I. General information

NPI: 1548942550
Provider Name (Legal Business Name): ENM THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 RANDOLPH ST NW
WASHINGTON DC
20011-5527
US

IV. Provider business mailing address

1339 RANDOLPH ST NW
WASHINGTON DC
20011-5527
US

V. Phone/Fax

Practice location:
  • Phone: 202-389-7653
  • Fax:
Mailing address:
  • Phone: 202-389-7653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ERICKA N MAHDI
Title or Position: CEO
Credential:
Phone: 202-389-7653