Healthcare Provider Details

I. General information

NPI: 1013838044
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES MO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 L'ENFANT SQUARE SE
WASHINGTON DC
20020-6724
US

IV. Provider business mailing address

1303 L'ENFANT SQUARE SE
WASHINGTON DC
20020-6724
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-2401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HERB GRAY
Title or Position: CEO
Credential:
Phone: 704-560-4332