Provider Demographics
NPI:1457464299
Name:INSTITUTE FOR LIFE ENRICHMENT PC
Entity Type:Organization
Organization Name:INSTITUTE FOR LIFE ENRICHMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-291-5008
Mailing Address - Street 1:7852 16TH STREET NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1204
Mailing Address - Country:US
Mailing Address - Phone:202-291-5009
Mailing Address - Fax:202-291-2080
Practice Address - Street 1:7852 16TH STREET NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1204
Practice Address - Country:US
Practice Address - Phone:202-291-5009
Practice Address - Fax:202-291-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY571103T00000X
MD02982103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD773211200Medicaid
DC023011400Medicaid
DC023011400Medicaid