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NPI Code Detail

MEDICARE: DIVORCE AND MARITAL STRESS CLINIC INC

MEDICARE: DIVORCE AND MARITAL STRESS CLINIC INC
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
11041C0700XClinical Social Worker0904000834VA

General Provider Information

NPI Number : 1407974843
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVORCE AND MARITAL STRESS CLINIC INC
Provider Business Mailing Address
First Line : 1600 WILSON BLVD
Second Line : SUITE 702
City : ARLINGTON
State : VA
Zip : 22209-2505
Country : US
Telephone Number : 703-528-3900
Fax Number : 703-524-7525
Provider Business Practice Location Address
First Line : 1600 WILSON BLVD
Second Line : SUITE 702
City : ARLINGTON
State : VA
Zip : 22209-2505
Country : US
Telephone Number : 703-528-3900
Fax Number : 703-524-7525
Authorized Official
Title or Position : DIRECTOR
Name : EMILY M BROWN
Credential : LCSW MSW
Telephone Number : 703-528-3900
Provider Enumeration Date : 03/26/2007
Last Update Date : 08/22/2020

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Directions to “DIVORCE AND MARITAL STRESS CLINIC INC ” Practice Location

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