MEDICARE: SRL CONSULTING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1851913941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SRL CONSULTING, LLC

Provider Business Mailing Address
First Line	:	1509 FORT DAVIS PL SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 FORT DAVIS PL SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6027
Country	:	US
Telephone Number	:	202-867-4839
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SADIQA LONG
Credential	:	LPC, NCC, ACS
Telephone Number	:	202-492-8239

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	05/12/2020

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Directions to “SRL CONSULTING, LLC ” Practice Location

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