Healthcare Provider Details

I. General information

NPI: 1619059789
Provider Name (Legal Business Name): NORTHERN VIRGINIA FAMILY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10455 WHITE GRANITE DR SUITE 100
OAKTON VA
22124-2764
US

IV. Provider business mailing address

10455 WHITE GRANITE DR SUITE 100
OAKTON VA
22124-2764
US

V. Phone/Fax

Practice location:
  • Phone: 703-219-2166
  • Fax: 703-385-6181
Mailing address:
  • Phone: 703-219-2166
  • Fax: 703-385-6181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCO-20-06
License Number StateVA

VIII. Authorized Official

Name: MS. SHARON S. FROST
Title or Position: VP, INTENSIVE FAMILY SERVICES
Credential: M.A.
Phone: 703-219-2125