Healthcare Provider Details

I. General information

NPI: 1750227856
Provider Name (Legal Business Name): HEAVEN ON EARTH THERAPEUTIC & WELLNESS SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6813 LAUREL ST NW
WASHINGTON DC
20012-2018
US

IV. Provider business mailing address

6218 GEORGIA AVE NW
WASHINGTON DC
20011-5125
US

V. Phone/Fax

Practice location:
  • Phone: 202-847-5155
  • Fax:
Mailing address:
  • Phone: 202-847-5155
  • 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: KRISTIN CHERISE JENNINGS
Title or Position: SOCIAL WORKER
Credential: LICSW
Phone: 202-847-5155