Healthcare Provider Details

I. General information

NPI: 1245789460
Provider Name (Legal Business Name): NOVA ADDICTION SPECIALISTS LLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N COLUMBUS ST SUITE 405
ALEXANDRIA VA
22314-3056
US

IV. Provider business mailing address

101 N COLUMBUS ST SUITE 405
ALEXANDRIA VA
22314-3056
US

V. Phone/Fax

Practice location:
  • Phone: 703-340-1304
  • Fax: 888-965-7708
Mailing address:
  • Phone: 703-340-1304
  • Fax: 888-965-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL HOMEYER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 703-340-1304