Healthcare Provider Details

I. General information

NPI: 1760067151
Provider Name (Legal Business Name): SAGE & FIFTH THERAPY PLACE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 CONNECTICUT AVE NW STE 700
WASHINGTON DC
20036-2657
US

IV. Provider business mailing address

1250 CONNECTICUT AVE NW STE 700
WASHINGTON DC
20036-2657
US

V. Phone/Fax

Practice location:
  • Phone: 202-935-5912
  • Fax:
Mailing address:
  • Phone: 202-935-5912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. HUMA SIKANDAR FATAKIA
Title or Position: FOUNDER & CEO
Credential: LPC
Phone: 202-935-5912