Healthcare Provider Details

I. General information

NPI: 1265225320
Provider Name (Legal Business Name): VICTORIA TRANSCULTURAL CLINICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10565 FAIRFAX BLVD STE 300
FAIRFAX VA
22030-3104
US

IV. Provider business mailing address

10565 FAIRFAX BLVD STE 300
FAIRFAX VA
22030-3104
US

V. Phone/Fax

Practice location:
  • Phone: 703-218-6599
  • Fax: 703-890-7167
Mailing address:
  • Phone: 703-218-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW COOK
Title or Position: SYSTEMS ADMIN
Credential:
Phone: 703-268-0429