Healthcare Provider Details

I. General information

NPI: 1114308384
Provider Name (Legal Business Name): PARADIGM INTEGRATIVE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2015
Last Update Date: 06/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE SUITE 470
WASHINGTON DC
20003-4318
US

IV. Provider business mailing address

650 PENNSYLVANIA AVE SE SUITE 470
WASHINGTON DC
20003-4318
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-0981
  • Fax: 202-747-7716
Mailing address:
  • Phone: 202-546-0981
  • Fax: 202-747-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberDO034414
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD10781
License Number StateDC

VIII. Authorized Official

Name: DR. HENRY NATHANIEL JENKINS JR.
Title or Position: CLINICAL DIRECTOR
Credential: DC
Phone: 202-546-0981