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General NPI Number Information
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NPI Number | 1982259594
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Entity Type | Organization
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Legal Business Name | HUMAN THEORY GROUP
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 2301 E ST NW APT A416
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City | WASHINGTON
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State | DC
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Zip | 20037-2806
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Country | US
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Telephone | 303-513-3391
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 E ST NW APT A416
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City | WASHINGTON
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State | DC
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Zip | 20037-2806
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Country | US
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Telephone | 303-513-3391
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JUSTIN GASPER JACQUES
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Credential | LPC
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Telephone | 303-513-3391
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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 |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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