Provider Demographics
NPI:1093471187
Name:LISTEN NUTRITION, LLC
Entity Type:Organization
Organization Name:LISTEN NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:202-670-9674
Mailing Address - Street 1:1602 BELLE VIEW BLVD
Mailing Address - Street 2:PMB 4170
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-2035
Mailing Address - Country:US
Mailing Address - Phone:585-506-5780
Mailing Address - Fax:
Practice Address - Street 1:8637 MATHIS AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5270
Practice Address - Country:US
Practice Address - Phone:202-670-9674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty