Healthcare Provider Details

I. General information

NPI: 1124952908
Provider Name (Legal Business Name): CHALLENGED HEARTS HEALING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 FAIRVIEW PARK DR STE 200 OFFICE #6
FALLS CHURCH VA
22042-4547
US

IV. Provider business mailing address

8401 MAYLAND DR STE A
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 315-456-9551
  • Fax:
Mailing address:
  • Phone: 315-456-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JULIA E SANDERS
Title or Position: OWNER/MEMBER
Credential: LCSW, LCSW-C, LICSW
Phone: 315-456-9551