Healthcare Provider Details

I. General information

NPI: 1588610679
Provider Name (Legal Business Name): MEIER CLINICS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 PENDER DR SUITE 305
FAIRFAX VA
22030-6041
US

IV. Provider business mailing address

3959 PENDER DR SUITE 305
FAIRFAX VA
22030-6041
US

V. Phone/Fax

Practice location:
  • Phone: 703-383-8333
  • Fax: 703-383-3183
Mailing address:
  • Phone: 703-383-8333
  • Fax: 703-383-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005066
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001651
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09040034
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number904004891
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101048081
License Number StateVA

VIII. Authorized Official

Name: SANDY NEWPORT
Title or Position: NATIONAL EXECUTIVE ASSISTANT
Credential:
Phone: 630-653-1717