Provider Demographics
NPI:1871043026
Name:PIERCE, HENRY III
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:PIERCE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54790
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-9390
Mailing Address - Country:US
Mailing Address - Phone:202-236-4362
Mailing Address - Fax:202-562-5602
Practice Address - Street 1:601 RALEIGH PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4221
Practice Address - Country:US
Practice Address - Phone:202-236-4362
Practice Address - Fax:202-562-5602
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC11215-264251B00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC041280200Medicaid
DC11215-264OtherASARS DC DEPARTMENT OF BEHAVIORAL HEALTH