Healthcare Provider Details

I. General information

NPI: 1518672864
Provider Name (Legal Business Name): RUAIR THERAPUTICS LLC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020F LORTON STATION BLVD STE 103
LORTON VA
22079-4799
US

IV. Provider business mailing address

12313 OAK CREEK LN APT 1515
FAIRFAX VA
22033-4240
US

V. Phone/Fax

Practice location:
  • Phone: 703-375-9111
  • Fax:
Mailing address:
  • Phone: 703-375-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ARRIEL WALKER
Title or Position: OWNER
Credential: LPC
Phone: 703-375-1111