Provider Demographics
NPI:1083127666
Name:THE HEALTHY PLACE LLC
Entity Type:Organization
Organization Name:THE HEALTHY PLACE LLC
Other - Org Name:THE HEALTHY PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:202-246-2855
Mailing Address - Street 1:4091 SILVER PARK TER
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3047
Mailing Address - Country:US
Mailing Address - Phone:202-246-2855
Mailing Address - Fax:
Practice Address - Street 1:4014 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5857
Practice Address - Country:US
Practice Address - Phone:202-246-2855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty