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General NPI Number Information
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NPI Number | 1194919035
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Entity Type | Organization
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Legal Business Name | AL NESTOR
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 6092 FRANCONIA RD
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City | ALEXANDRIA
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State | VA
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Zip | 22310-1741
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Country | US
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Telephone | 703-922-0443
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Fax | 703-922-0603
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Provider Business Mailing Address
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Address Line | 6092 FRANCONIA RD
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City | ALEXANDRIA
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State | VA
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Zip | 22310-1741
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Country | US
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Telephone | 703-922-0443
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Fax | 703-922-0603
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Authorized Official
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Title or Position | OWNER
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Name | MR. AL NESTOR
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Credential | LCSW
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Telephone | 703-922-0443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904000057
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License Number State | VA
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