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General NPI Number Information
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NPI Number | 1720303001
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Entity Type | Organization
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Legal Business Name | KEY CENTER
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 44081 PIPELINE PLZ STE 100-1
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City | ASHBURN
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State | VA
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Zip | 20147-5891
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Country | US
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Telephone | 703-728-7650
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Fax | 571-223-7853
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Provider Business Mailing Address
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Address Line | 44081 PIPELINE PLZ STE 100-1
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City | ASHBURN
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State | VA
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Zip | 20147-5891
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Country | US
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Telephone | 703-728-7650
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Fax | 571-223-7853
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Authorized Official
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Title or Position | OWNER
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Name | MS. JANIS MANALANG
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Credential | LPC
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Telephone | 703-728-7650
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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 | 0701004434
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License Number State | VA
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