Healthcare Provider Details

I. General information

NPI: 1548493984
Provider Name (Legal Business Name): ARLINGTON FREE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 SOUTH 11TH ST
ARLINGTON VA
22204
US

IV. Provider business mailing address

2921 SOUTH 11TH ST
ARLINGTON VA
22204
US

V. Phone/Fax

Practice location:
  • Phone: 703-979-1425
  • Fax: 703-979-1436
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDY DIETRICK
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 703-979-1425