Healthcare Provider Details

I. General information

NPI: 1780210344
Provider Name (Legal Business Name): VICTORIA TOADVINE NEALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA ELAINE NEALE

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7969 ASHTON AVE
MANASSAS VA
20109-2885
US

IV. Provider business mailing address

10607 OLD MARSH RD
BEALETON VA
22712-6837
US

V. Phone/Fax

Practice location:
  • Phone: 703-792-7800
  • Fax: 703-792-5699
Mailing address:
  • Phone: 571-283-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008842
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: