Healthcare Provider Details

I. General information

NPI: 1851424832
Provider Name (Legal Business Name): PRINCE WILLIAM COUNTY COMMUNITY SERVICES BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7969 ASHTON AVE
MANASSAS VA
20109-2885
US

IV. Provider business mailing address

7969 ASHTON AVE
MANASSAS VA
20109-2885
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. TOM GEIB
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 703-792-7800