Healthcare Provider Details

I. General information

NPI: 1811861248
Provider Name (Legal Business Name): JALISSA WORTHY LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MARTIN LUTHER KING JR AVE SE STE 300
WASHINGTON DC
20032-1542
US

IV. Provider business mailing address

3400 MARTIN LUTHER KING JR AVE SE STE 300
WASHINGTON DC
20032-1542
US

V. Phone/Fax

Practice location:
  • Phone: 202-724-7666
  • Fax:
Mailing address:
  • Phone: 202-724-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200004860
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: