Provider Demographics
NPI:1760067151
Name:SAGE & FIFTH THERAPY PLACE PLLC
Entity Type:Organization
Organization Name:SAGE & FIFTH THERAPY PLACE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HUMA
Authorized Official - Middle Name:SIKANDAR
Authorized Official - Last Name:FATAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:202-935-5912
Mailing Address - Street 1:1250 CONNECTICUT AVE NW STE 700
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-2657
Mailing Address - Country:US
Mailing Address - Phone:202-935-5912
Mailing Address - Fax:
Practice Address - Street 1:1250 CONNECTICUT AVE NW STE 700
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2657
Practice Address - Country:US
Practice Address - Phone:202-935-5912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty