Healthcare Provider Details

I. General information

NPI: 1538408364
Provider Name (Legal Business Name): STRESS CENTRE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10529 CRESTWOOD DR SUITE # 101
MANASSAS VA
20109-4418
US

IV. Provider business mailing address

10529 CRESTWOOD DR SUITE # 101
MANASSAS VA
20109-4418
US

V. Phone/Fax

Practice location:
  • Phone: 703-392-6420
  • Fax: 703-392-6421
Mailing address:
  • Phone: 703-392-6420
  • Fax: 703-392-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0015000200
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0015000200
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number0015000200
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number0015000200
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0015000200
License Number StateVA

VIII. Authorized Official

Name: DR. SEGUNDA YANEX ACOSTA
Title or Position: PRESIDENT
Credential:
Phone: 703-392-6410