Healthcare Provider Details

I. General information

NPI: 1225950116
Provider Name (Legal Business Name): BACKYARD GARDEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 21ST RD N APT 4
ARLINGTON VA
22207-2230
US

IV. Provider business mailing address

4750 21ST RD N APT 4
ARLINGTON VA
22207-2230
US

V. Phone/Fax

Practice location:
  • Phone: 443-614-1204
  • Fax:
Mailing address:
  • Phone: 443-614-1204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAUREN LAQUE
Title or Position: OWNER/MENTAL HEALTH CLINICIAN
Credential: LCSW-C
Phone: 443-614-1204