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General NPI Number Information
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NPI Number | 1003257726
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA ADOLESCENT AND ADULT THERAPY, INC.
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 228 S WASHINGTON ST SUITE 330
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City | ALEXANDRIA
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State | VA
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Zip | 22314-5408
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Country | US
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Telephone | 518-483-5002
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Fax | 571-312-9526
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Provider Business Mailing Address
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Address Line | 8424 WASHINGTON AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22309-2319
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Country | US
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Telephone | 518-522-3628
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Fax | 571-312-9526
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BONNIE MANUEL
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Credential | LCSW, CSOTP
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Telephone | 518-522-3628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0904007238
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License Number State | VA
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