Healthcare Provider Details

I. General information

NPI: 1922123454
Provider Name (Legal Business Name): ESTELLE PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16206 KINGS VALLEY DR
DUMFRIES VA
22025-1738
US

IV. Provider business mailing address

17964 SWANS CREEK LN
DUMFRIES VA
22026-4526
US

V. Phone/Fax

Practice location:
  • Phone: 703-680-4428
  • Fax: 703-221-9919
Mailing address:
  • Phone: 703-221-9929
  • Fax: 703-221-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number755-02-006
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number755-01-001
License Number StateVA

VIII. Authorized Official

Name: MRS. DEBORAH C ROUNDTREE
Title or Position: CEO
Credential: MA
Phone: 703-221-9929