Healthcare Provider Details

I. General information

NPI: 1265494207
Provider Name (Legal Business Name): CENTER FOR MULTICULTURAL HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W BROAD ST 305
FALLS CHURCH VA
22046-3220
US

IV. Provider business mailing address

701 W BROAD ST 305
FALLS CHURCH VA
22046-3220
US

V. Phone/Fax

Practice location:
  • Phone: 703-533-3302
  • Fax: 703-237-2083
Mailing address:
  • Phone: 703-533-3302
  • Fax: 703-237-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number108
License Number StateVA

VIII. Authorized Official

Name: REBECCA GABA
Title or Position: ACTING EXECUTIVE DIRECTOR
Credential:
Phone: 703-533-3302