Healthcare Provider Details

I. General information

NPI: 1407610934
Provider Name (Legal Business Name): TEN TEN LIFE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 THOROUGHBRED RD
HERNDON VA
20171-2008
US

IV. Provider business mailing address

PO BOX 742
HERNDON VA
20172-0742
US

V. Phone/Fax

Practice location:
  • Phone: 703-258-2799
  • Fax:
Mailing address:
  • Phone: 855-367-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID C STEELE
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 855-367-1010