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General NPI Number Information
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NPI Number | 1184173957
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Entity Type | Organization
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Legal Business Name | FAMILY THERAPEUTICS, INC.
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 10353B DEMOCRACY LN
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City | FAIRFAX
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State | VA
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Zip | 22030-2505
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Country | US
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Telephone | 703-405-4171
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Fax |
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Provider Business Mailing Address
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Address Line | 10353B DEMOCRACY LN
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City | FAIRFAX
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State | VA
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Zip | 22030-2505
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Country | US
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Telephone | 703-405-4171
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TANYA KAY HULL
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Credential | LPC
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Telephone | 703-405-4171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003068
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License Number State | VA
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