Healthcare Provider Details

I. General information

NPI: 1679405153
Provider Name (Legal Business Name): ALDERICK VAN KINCHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 COLUMBIA PIKE APT 515
ARLINGTON VA
22204-5859
US

IV. Provider business mailing address

5500 COLUMBIA PIKE APT 515
ARLINGTON VA
22204-5859
US

V. Phone/Fax

Practice location:
  • Phone: 202-977-8402
  • Fax:
Mailing address:
  • Phone: 202-977-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: