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General NPI Number Information
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NPI Number | 1750442224
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Entity Type | Organization
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Legal Business Name | LIFE ENHANCEMENT SERVICES, LLC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 1818 NEW YORK AVE NE STE 115
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City | WASHINGTON
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State | DC
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Zip | 20002-1851
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Country | US
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Telephone | 202-269-2401
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Fax | 202-269-2402
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Provider Business Mailing Address
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Address Line | 1818 NEW YORK AVE NE STE 115
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City | WASHINGTON
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State | DC
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Zip | 20002-1851
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Country | US
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Telephone | 202-269-2401
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Fax | 202-269-2402
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Authorized Official
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Title or Position | OWNER
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Name | HERBERT GRAY III
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Credential |
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Telephone | 202-269-2401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NC
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