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General NPI Number Information
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NPI Number | 1487030532
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Entity Type | Organization
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Legal Business Name | TRAUMA AND HOPE
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 8317 BLUEBIRD WAY UNIT K
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City | LORTON
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State | VA
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Zip | 22079-2844
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Country | US
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Telephone | 571-366-0086
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Fax |
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Provider Business Mailing Address
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Address Line | 8317 BLUEBIRD WAY UNIT K
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City | LORTON
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State | VA
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Zip | 22079-2844
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DEEPA PATEL
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Credential | CSOTP, LCSW
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Telephone | 571-366-0086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0904007859
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License Number State | VA
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