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General NPI Number Information
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NPI Number | 1295107969
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR CONNECTION, HEALING & CHANGE
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 12751 MARBLESTONE DR SUITE 200
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City | WOODBRIDGE
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State | VA
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Zip | 22192-8335
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Country | US
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Telephone | 703-878-3291
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Fax |
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Provider Business Mailing Address
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Address Line | 12751 MARBLESTONE DR SUITE 200
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City | WOODBRIDGE
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State | VA
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Zip | 22192-8335
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Country | US
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Telephone | 703-878-3291
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | ELAYNE SMITH
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Credential | LMFT
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Telephone | 571-408-1161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT000175
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License Number State | DC
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