Healthcare Provider Details

I. General information

NPI: 1275073173
Provider Name (Legal Business Name): LLI LEADERSHIP DEVELOPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 6TH STREET SE #304
WASHINGTON DC
20032
US

IV. Provider business mailing address

3300 6TH STREET SE #314
WASHINGTON DC
20032
US

V. Phone/Fax

Practice location:
  • Phone: 202-702-8663
  • Fax:
Mailing address:
  • Phone: 202-702-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA A WOODLAND
Title or Position: CEO
Credential:
Phone: 202-702-8663