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General NPI Number Information
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NPI Number | 1902133218
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Entity Type | Organization
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Legal Business Name | ADVANTAGE THERAPY CENTER
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 9352 BIRCHFIELD WAY
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City | LORTON
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State | VA
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Zip | 22079-3440
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Country | US
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Telephone | 703-409-6258
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Fax |
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Provider Business Mailing Address
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Address Line | 915 LAFAYETTE BLVD # C
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-5667
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Country | US
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Telephone | 540-654-5113
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Fax | 540-654-5859
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. HOANG OANH RODGERS
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Credential | L.P.C. L.M.F.T.
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Telephone | 540-654-5113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710000893
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717000800
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0717000800
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License Number State | VA
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