Healthcare Provider Details

I. General information

NPI: 1518617232
Provider Name (Legal Business Name): JOE CABUSH & ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 OLD LEE HWY STE 43B
FAIRFAX VA
22030-2434
US

IV. Provider business mailing address

3911 OLD LEE HWY STE 43B
FAIRFAX VA
22030-2434
US

V. Phone/Fax

Practice location:
  • Phone: 703-691-0036
  • Fax:
Mailing address:
  • Phone: 703-691-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH CABUSH
Title or Position: MANAGER
Credential: LCSW
Phone: 703-691-0036