Healthcare Provider Details

I. General information

NPI: 1205165636
Provider Name (Legal Business Name): BEHAVIORAL HEALTH ARLINGTON COUNTY DHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 N GEORGE MASON DR
ARLINGTON VA
22205-3675
US

IV. Provider business mailing address

1725 NORTH GEOGRE MASON DRIVE
ARLINGTON VA
22205
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-5150
  • Fax: 703-228-5157
Mailing address:
  • Phone: 703-228-5150
  • Fax: 703-228-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number0001151480
License Number StateVA

VIII. Authorized Official

Name: MRS. LARISSA JOAN ROGERS
Title or Position: PUBLIC HEALTH NURSE
Credential: RN
Phone: 703-228-4996