Healthcare Provider Details

I. General information

NPI: 1336766740
Provider Name (Legal Business Name): EARNST ILANG-ILANG II LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
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 Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200004060
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG500883130
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: