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General NPI Number Information
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NPI Number | 1386937829
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Entity Type | Organization
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Legal Business Name | CYCLELOGICAL CONNECTION INC
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 42979 GOLF VIEW DR SUITE 201
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City | CHANTILLY
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State | VA
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Zip | 20152-2006
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Country | US
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Telephone | 301-706-0996
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Fax | 571-248-0758
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Provider Business Mailing Address
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Address Line | 42979 GOLF VIEW DR SUITE 201
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City | CHANTILLY
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State | VA
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Zip | 20152-2006
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Country | US
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Telephone | 301-706-0996
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Fax | 571-248-0758
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MRS. SUSAN F PITI
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Credential | LPC
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Telephone | 571-248-0757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 0701004053
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License Number State | VA
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