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General NPI Number Information
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NPI Number | 1689197790
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA ART THERAPY, LLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 1008 PENDLETON ST STE 1A
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2182
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Country | US
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Telephone | 703-596-9557
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 PENDLETON ST STE 1A
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2182
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Country | US
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Telephone | 703-596-9557
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADELE STUCKEY
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Credential | MA, LPC, ATR-BC
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Telephone | 703-596-9557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007203
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License Number State | VA
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