Healthcare Provider Details

I. General information

NPI: 1104469014
Provider Name (Legal Business Name): ROCK RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 FORT MYER DR STE 1130
ARLINGTON VA
22209-1606
US

IV. Provider business mailing address

PO BOX 100923
ARLINGTON VA
22210-3923
US

V. Phone/Fax

Practice location:
  • Phone: 571-255-9906
  • Fax:
Mailing address:
  • Phone: 712-559-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE DONDERO BETTWY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 571-255-9906