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General NPI Number Information
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NPI Number | 1376660233
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Entity Type | Organization
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Legal Business Name | LIVING FREE HEALTH SERVICES
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 4306 EVERGREEN LN STE 204
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City | ANNANDALE
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State | VA
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Zip | 22003-3217
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Country | US
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Telephone | 703-750-1292
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Fax | 703-642-0859
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Provider Business Mailing Address
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Address Line | 4306 EVERGREEN LN STE 204
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City | ANNANDALE
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State | VA
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Zip | 22003-3217
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Country | US
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Telephone | 703-750-1292
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Fax | 703-642-0859
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARIETTA WARDEN
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Credential | R.N., C.C.S.,C.A.C
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Telephone | 703-750-1292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 149
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License Number State | VA
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