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General NPI Number Information
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NPI Number | 1104204262
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Entity Type | Organization
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Legal Business Name | OUTSTANDING POSSIBILITIES REVEALED, LLP
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Dates
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Enumeration Date | 05/09/2015
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Last Update Date | 05/30/2016
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Provider Practice Location Address
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Address Line | 3022 JAVIER RD SUITE 130
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City | FAIRFAX
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State | VA
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Zip | 22031-4645
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Country | US
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Telephone | 202-888-6533
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Fax |
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Provider Business Mailing Address
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Address Line | 3022 JAVIER RD SUITE 130
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City | FAIRFAX
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State | VA
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Zip | 22031-4645
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Country | US
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Telephone | 202-888-6533
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ALTHEA AZU
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Credential |
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Telephone | 301-806-1711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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