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General NPI Number Information
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NPI Number | 1992910723
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERAN AFFAIRS
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 4500 S LANCASTER RD MH COPPER TEAM 116A
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 214-857-0912
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Fax |
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Provider Business Mailing Address
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Address Line | 610 JAGERA WAY
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City | ARLINGTON
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State | TX
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Zip | 76002-4582
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Country | US
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Telephone | 214-857-0912
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH SOCIAL WORKER
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Name | MRS. DIANA WILLIS
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Credential | L.M.S.W.
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Telephone | 214-857-0912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 50681
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License Number State | TX
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