Healthcare Provider Details

I. General information

NPI: 1386753291
Provider Name (Legal Business Name): COUNTY OF LOUDOUN, VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HERITAGE WAY NE SUITE 310
LEESBURG VA
20176-4544
US

IV. Provider business mailing address

906 TRAILVIEW BLVD SE SUITE C
LEESBURG VA
20175-4415
US

V. Phone/Fax

Practice location:
  • Phone: 703-737-8677
  • Fax: 703-737-8676
Mailing address:
  • Phone: 703-737-8677
  • Fax: 703-737-8676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number143
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number143
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number143
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number143
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number143
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number143
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number143
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number143
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number143
License Number StateVA
# 10
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number143
License Number StateVA
# 11
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number143
License Number StateVA

VIII. Authorized Official

Name: MS. MARGARET GRAHAM
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 703-771-5406