Healthcare Provider Details

I. General information

NPI: 1811225089
Provider Name (Legal Business Name): JAMES M TRUXELL M.DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 KINGS WAY
FAIRFAX VA
22033-3200
US

IV. Provider business mailing address

4094 MAJESTIC LN #237
FAIRFAX VA
22033-2104
US

V. Phone/Fax

Practice location:
  • Phone: 703-449-1944
  • Fax: 703-378-9369
Mailing address:
  • Phone: 703-449-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: