Healthcare Provider Details

I. General information

NPI: 1316143712
Provider Name (Legal Business Name): TOTAL HEALTH CONCEPTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 EAST ST NE
VIENNA VA
22180
US

IV. Provider business mailing address

169 EAST ST NE
VIENNA VA
22180
US

V. Phone/Fax

Practice location:
  • Phone: 703-255-7012
  • Fax: 703-255-6171
Mailing address:
  • Phone: 703-255-7012
  • Fax: 703-255-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004788
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD00774
License Number StateVA

VIII. Authorized Official

Name: MS. VIRGINIA INGLESE
Title or Position: OWNER PRESIDENT
Credential: LCSW RD
Phone: 703-255-7012