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General NPI Number Information
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NPI Number | 1952360612
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Entity Type | Organization
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Legal Business Name | MULTICULTURAL CLINICAL CENTER
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6563 EDSALL RD
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City | SPRINGFIELD
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State | VA
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Zip | 22151-4414
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Country | US
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Telephone | 703-354-0000
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Fax | 703-354-1129
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Provider Business Mailing Address
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Address Line | 6563 EDSALL RD
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City | SPRINGFIELD
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State | VA
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Zip | 22151-4414
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Country | US
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Telephone | 703-354-0000
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Fax | 703-354-1129
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. REBECCA KEEGAN
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Credential | L.C.S.W.
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Telephone | 703-354-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 123
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License Number State | VA
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