Provider Demographics
NPI:1043716178
Name:ENLIGHTEN THERAPEUTIC & CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:ENLIGHTEN THERAPEUTIC & CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEYONA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-356-3818
Mailing Address - Street 1:920 PALMER RD APT 14
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4674
Mailing Address - Country:US
Mailing Address - Phone:301-356-3818
Mailing Address - Fax:
Practice Address - Street 1:46 RIVERSIDE RUN DR
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-2044
Practice Address - Country:US
Practice Address - Phone:301-356-3818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)