Healthcare Provider Details

I. General information

NPI: 1043660905
Provider Name (Legal Business Name): SAFE HARBOR BEHAVIORAL CARE OF NORTHERN VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 GROVEDALE DR STE 200
ALEXANDRIA VA
22310-2596
US

IV. Provider business mailing address

547 TWIN LAKES LN
BUMPASS VA
23024-4671
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-4600
  • Fax: 443-640-4358
Mailing address:
  • Phone: 410-893-4600
  • Fax: 443-640-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY CROSSON
Title or Position: REGIONAL DIRECTOR
Credential:
Phone: 410-893-4600