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General NPI Number Information
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NPI Number | 1528819067
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Entity Type | Organization
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Legal Business Name | THREE BRANCHES THERAPY, LLC
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 22219 MCQUAY HEIGHTS LN
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City | MIDDLEBURG
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State | VA
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Zip | 20117-3838
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Country | US
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Telephone | 703-254-7863
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 713
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City | MIDDLEBURG
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State | VA
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Zip | 20118-0713
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Country | US
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Telephone | 703-254-7863
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | KATHERINE ELIZABETH KERNUS
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Credential | LPC, NCC
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Telephone | 703-254-7863
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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 |
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License Number State |
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