Healthcare Provider Details

I. General information

NPI: 1730494329
Provider Name (Legal Business Name): CHOSEN ONE THERAPIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10851 TIDEWATER TRIAL #103
FREDERICKSBURG VA
22408-0260
US

IV. Provider business mailing address

17775 MAIN ST STE 104
DUMFRIES VA
22026-2491
US

V. Phone/Fax

Practice location:
  • Phone: 571-330-8120
  • Fax: 877-771-3419
Mailing address:
  • Phone: 540-693-6997
  • Fax: 877-771-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. DENIECE M PAYNE
Title or Position: CLINICAL DIRECTOR
Credential: MS-SLP, MED
Phone: 571-330-8120