Healthcare Provider Details

I. General information

NPI: 1033572789
Provider Name (Legal Business Name): CENTER FOR VETERANS IN TRANSITION , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 WISCONSIN AVE NW
WASHINGTON DC
20016-4624
US

IV. Provider business mailing address

12097 EDGEMERE CIR
RESTON VA
20190-3260
US

V. Phone/Fax

Practice location:
  • Phone: 571-271-7284
  • Fax:
Mailing address:
  • Phone: 571-271-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC14512
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberLC6275
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberCACII1158
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0710102822
License Number StateVA

VIII. Authorized Official

Name: MR. STEVE ZAPPALLA
Title or Position: DIRECTOR
Credential: LPC
Phone: 571-271-7289