Healthcare Provider Details

I. General information

NPI: 1043920242
Provider Name (Legal Business Name): DMV TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 GREENSBORO STATION PL STE 900
MC LEAN VA
22102-3470
US

IV. Provider business mailing address

1765 GREENSBORO STATION PL STE 900
MC LEAN VA
22102-3470
US

V. Phone/Fax

Practice location:
  • Phone: 703-839-0143
  • Fax:
Mailing address:
  • Phone: 703-839-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER SCHUBERT
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 703-839-0143