Healthcare Provider Details

I. General information

NPI: 1831722313
Provider Name (Legal Business Name): ALEXANDRIA THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 MOUNT VERNON AVE STE 204
ALEXANDRIA VA
22301-1361
US

IV. Provider business mailing address

2210 MOUNT VERNON AVE # ARE204
ALEXANDRIA VA
22301-1394
US

V. Phone/Fax

Practice location:
  • Phone: 703-286-0406
  • Fax:
Mailing address:
  • Phone: 703-286-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGEL DANIELS
Title or Position: OWNER
Credential: PHD
Phone: 703-286-0406