=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285826230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALINGTON CO. DEPT. OF HUMAN RESOURCES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2007
-----------------------------------------------------
Last Update Date | 08/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3033 WILSON BLVD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22201-3843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-228-1754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3033 WILSON BLVD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22201-3843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-228-1754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH THERAPIST II
-----------------------------------------------------
Name | MS. VERONICA J. KELLY
-----------------------------------------------------
Credential | RN, LCSW
-----------------------------------------------------
Telephone | 703-228-1754
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 0904004499
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------