Healthcare Provider Details

I. General information

NPI: 1609654631
Provider Name (Legal Business Name): INTEGRATED HEALTH RECOVERY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7837 SEAFARER WAY
LORTON VA
22079-2137
US

IV. Provider business mailing address

7837 SEAFARER WAY
LORTON VA
22079-2137
US

V. Phone/Fax

Practice location:
  • Phone: 703-209-5092
  • Fax:
Mailing address:
  • Phone: 703-209-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: JANA BERHOW
Title or Position: CEO
Credential: LICSW, EMBA
Phone: 703-209-5092