Healthcare Provider Details

I. General information

NPI: 1730859885
Provider Name (Legal Business Name): COMPASSIONATE THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2021
Last Update Date: 09/19/2021
Certification Date: 09/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 17TH ST S
ARLINGTON VA
22202-2602
US

IV. Provider business mailing address

1301 S FERN ST UNIT 25351
ARLINGTON VA
22202-5964
US

V. Phone/Fax

Practice location:
  • Phone: 571-969-5264
  • Fax:
Mailing address:
  • Phone: 571-969-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. KAMARIA ARIEL SIDMAN
Title or Position: PRINCIPAL
Credential:
Phone: 571-969-5264