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General NPI Number Information
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NPI Number | 1790178713
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Entity Type | Organization
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Legal Business Name | CLINICAL THERAPY SERVICES
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 9405 LARKDALE TER
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-3136
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Country | US
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Telephone | 703-581-7863
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Fax |
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Provider Business Mailing Address
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Address Line | 9405 LARKDALE TER
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-3136
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Country | US
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Telephone | 703-581-7863
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Fax | 703-581-7863
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Authorized Official
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Title or Position | INDIPENDENT CLINICAL SOCIAL WORKER
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Name | SHIRLEY FRANCIS WILLIAMS X
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Credential | LCSW-C,
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Telephone | 703-581-7863
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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 | 10522
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LC303400
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0904003799
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License Number State | VA
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