Healthcare Provider Details

I. General information

NPI: 1871995126
Provider Name (Legal Business Name): NATIONAL CAPITAL TREATMENT AND RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4317 6TH ST S
ARLINGTON VA
22204-1411
US

IV. Provider business mailing address

200 N GLEBE RD SUITE 104
ARLINGTON VA
22203-3728
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-0703
  • Fax: 703-243-0975
Mailing address:
  • Phone: 703-841-0703
  • Fax: 703-243-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number122-01-007
License Number StateVA

VIII. Authorized Official

Name: DAVID NICHOLAS
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 703-825-8762