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General NPI Number Information
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NPI Number | 1831722313
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA THERAPY, LLC
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 2210 MOUNT VERNON AVE STE 204
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City | ALEXANDRIA
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State | VA
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Zip | 22301-1361
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Country | US
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Telephone | 703-286-0406
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Fax |
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Provider Business Mailing Address
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Address Line | 2210 MOUNT VERNON AVE # ARE204
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City | ALEXANDRIA
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State | VA
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Zip | 22301-1394
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Country | US
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Telephone | 703-286-0406
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGEL DANIELS
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Credential | PHD
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Telephone | 703-286-0406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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