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General NPI Number Information
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NPI Number | 1750195749
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Entity Type | Organization
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Legal Business Name | BEYOND CLOSED DOORS THERAPY PLLC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 03/02/2025
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Provider Practice Location Address
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Address Line | 10246 DALE DR
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City | FAIRFAX
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State | VA
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Zip | 22030-2302
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Country | US
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Telephone | 301-799-5216
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Fax |
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Provider Business Mailing Address
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Address Line | 225 RESERVE BLVD APT 302
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-1665
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Country | US
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Telephone | 631-965-9493
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AZARIA ZHANE DAVIS
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Credential | LCSW
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Telephone | 631-965-9493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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