MEDICARE: EVERHART THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1497341523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERHART THERAPY LLC

Provider Business Mailing Address
First Line	:	107 S WEST ST STE 578
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2824
Country	:	US
Telephone Number	:	571-402-5410
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 N FAIRFAX ST STE 200
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2625
Country	:	US
Telephone Number	:	571-360-4083
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	LINDSAY JANE EVERHART
Credential	:	LCSW
Telephone Number	:	571-360-4083

Provider Enumeration Date	:	12/13/2020
Last Update Date	:	12/26/2021

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Directions to “EVERHART THERAPY LLC ” Practice Location

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