Healthcare Provider Details

I. General information

NPI: 1699135244
Provider Name (Legal Business Name): CENTER FOR BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 OFFICE PL STE 201
WOODBRIDGE VA
22192-4213
US

IV. Provider business mailing address

13601 OFFICE PL STE 201
WOODBRIDGE VA
22192-4213
US

V. Phone/Fax

Practice location:
  • Phone: 703-492-8939
  • Fax: 703-763-3006
Mailing address:
  • Phone: 703-492-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HUSAM K ALATHARI
Title or Position: PARTNER
Credential: MD
Phone: 703-492-5584