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General NPI Number Information
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NPI Number | 1760067151
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Entity Type | Organization
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Legal Business Name | SAGE & FIFTH THERAPY PLACE PLLC
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 1250 CONNECTICUT AVE NW STE 700
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City | WASHINGTON
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State | DC
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Zip | 20036-2657
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Country | US
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Telephone | 202-935-5912
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 CONNECTICUT AVE NW STE 700
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City | WASHINGTON
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State | DC
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Zip | 20036-2657
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Country | US
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Telephone | 202-935-5912
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | MRS. HUMA SIKANDAR FATAKIA
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Credential | LPC
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Telephone | 202-935-5912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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