Healthcare Provider Details

I. General information

NPI: 1194426981
Provider Name (Legal Business Name): HENRY LEVI SANDERS III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 PEABODY ST NW
WASHINGTON DC
20011-2203
US

IV. Provider business mailing address

228 PEABODY ST NW
WASHINGTON DC
20011-2203
US

V. Phone/Fax

Practice location:
  • Phone: 202-446-8256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number4828336
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: