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General NPI Number Information
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NPI Number | 1962832741
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Entity Type | Organization
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Legal Business Name | NCITEWITHN, LLC
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 10195 MAIN ST STE N
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City | FAIRFAX
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State | VA
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Zip | 22031-3415
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Country | US
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Telephone | 703-909-1072
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Fax | 703-690-0674
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Provider Business Mailing Address
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Address Line | 8749 FLOWERING DOGWOOD LN
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City | LORTON
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State | VA
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Zip | 22079-5603
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Country | US
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Telephone | 703-909-1072
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Fax | 703-690-0674
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | FELICEA C. MEYER-DELOATCH
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Credential | LCSW
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Telephone | 703-909-1072
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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 | 0904008028
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License Number State | VA
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