Healthcare Provider Details

I. General information

NPI: 1851913941
Provider Name (Legal Business Name): SRL CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 FORT DAVIS PL SE
WASHINGTON DC
20020-6027
US

IV. Provider business mailing address

1509 FORT DAVIS PL SE
WASHINGTON DC
20020-6027
US

V. Phone/Fax

Practice location:
  • Phone: 202-867-4839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SADIQA LONG
Title or Position: CEO
Credential: LPC, NCC, ACS
Phone: 202-492-8239