Healthcare Provider Details

I. General information

NPI: 1952638843
Provider Name (Legal Business Name): LOVE, LIGHT AND LIBERTY MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 K ST NW SUITE 350
WASHINGTON DC
20005-3500
US

IV. Provider business mailing address

1425 K ST NW SUITE 350
WASHINGTON DC
20005-3500
US

V. Phone/Fax

Practice location:
  • Phone: 202-587-2732
  • Fax: 202-587-5601
Mailing address:
  • Phone: 202-587-2732
  • Fax: 202-587-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLC301442
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberLC301442
License Number StateDC

VIII. Authorized Official

Name: MR. CLINTON JONATHAN ANDERSON
Title or Position: PASTOR/FOUNDER
Credential:
Phone: 202-587-2732