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General NPI Number Information
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NPI Number | 1598579070
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Entity Type | Organization
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Legal Business Name | ALOHA THERAPY FOR WELLNESS LLC
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 10805 MAIN ST STE 500
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City | FAIRFAX
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State | VA
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Zip | 22030-4747
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Country | US
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Telephone | 571-583-2372
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Fax |
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Provider Business Mailing Address
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Address Line | 6202 SIMPSON PATENT CT
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-1346
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Country | US
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Telephone | 703-626-1282
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY DIANE YOUNG
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Credential |
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Telephone | 703-626-1282
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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 |
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License Number State |
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