Healthcare Provider Details

I. General information

NPI: 1073258273
Provider Name (Legal Business Name): ENGLEFIELDPSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N PAYNE ST
ALEXANDRIA VA
22314-2444
US

IV. Provider business mailing address

1017 DALEBROOK DR
ALEXANDRIA VA
22308-2615
US

V. Phone/Fax

Practice location:
  • Phone: 703-307-7855
  • Fax:
Mailing address:
  • Phone: 703-307-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW ENGLEFIELD
Title or Position: OWNER
Credential:
Phone: 703-307-7855