MEDICARE: SALUS VITA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	0904009738	VA

General Provider Information

NPI Number	:	1275054033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALUS VITA

Provider Business Mailing Address
First Line	:	505 WYTHE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-1917
Country	:	US
Telephone Number	:	703-828-7159
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 WYTHE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-1917
Country	:	US
Telephone Number	:	703-828-7159
Fax Number	:

Authorized Official
Title or Position	:	CEO/ LEAD THERAPIST
Name	:	MS. GLORIA SAEZ
Credential	:	LICSW/ LCSW
Telephone Number	:	703-828-7159

Provider Enumeration Date	:	07/02/2017
Last Update Date	:	03/22/2023

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Directions to “SALUS VITA ” Practice Location

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