Provider Demographics
NPI:1477205433
Name:ENLIGHTEN NUTRITION COUNSELING AND CARE, LLC
Entity Type:Organization
Organization Name:ENLIGHTEN NUTRITION COUNSELING AND CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:SERAMUR
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS RDN LDN
Authorized Official - Phone:571-291-0693
Mailing Address - Street 1:11707 SUMMERCHASE CIR APT E
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1129
Mailing Address - Country:US
Mailing Address - Phone:571-291-0693
Mailing Address - Fax:
Practice Address - Street 1:2 CARDINAL PARK DR SE STE 104
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4437
Practice Address - Country:US
Practice Address - Phone:571-310-6029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA86109263Medicaid