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General NPI Number Information
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NPI Number | 1831264738
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Entity Type | Organization
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Legal Business Name | PHOENIX FAMILY COUNSELING & PLAY THERAPY CENTER, PLLC
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7404 GALLERHER RD SUITE 100
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City | GAINESVILLE
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State | VA
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Zip | 20155
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Country | US
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Telephone | 703-909-8963
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Fax | 703-753-5193
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Provider Business Mailing Address
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Address Line | 4350 SNOW HILL DR.
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City | GAINESVILLE
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State | VA
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Zip | 20155
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Country | US
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Telephone | 703-909-8963
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARY CATHERINE SPOONER
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Credential | LCSW
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Telephone | 703-909-8963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904003525
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License Number State | VA
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