Healthcare Provider Details

I. General information

NPI: 1174193825
Provider Name (Legal Business Name): OUR COMMUNITY SOLUTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14960 POTOMAC HEIGHTS PL APT 113
WOODBRIDGE VA
22191-6254
US

IV. Provider business mailing address

14960 POTOMAC HEIGHTS PL APT 113
WOODBRIDGE VA
22191-6254
US

V. Phone/Fax

Practice location:
  • Phone: 336-423-3942
  • Fax:
Mailing address:
  • Phone: 336-423-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name: CANDANCE DORAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-423-3942