Healthcare Provider Details

I. General information

NPI: 1558560631
Provider Name (Legal Business Name): EXCEPTIONAL CHILDRENS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6354 WALKER LN STE 250
ALEXANDRIA VA
22310-3229
US

IV. Provider business mailing address

6354 WALKER LN STE 250
ALEXANDRIA VA
22310-3229
US

V. Phone/Fax

Practice location:
  • Phone: 703-971-0602
  • Fax: 949-863-6813
Mailing address:
  • Phone: 37-971-0602
  • Fax: 949-863-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119002935
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006336
License Number StateVA

VIII. Authorized Official

Name: PHILIP GREER
Title or Position: OWNER
Credential:
Phone: 571-603-5863