MEDICARE: COMPASSIONATE THERAPY CENTER, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101Y00000X	Counselor

General Provider Information

NPI Number	:	1730859885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE THERAPY CENTER, LLC

Provider Business Mailing Address
First Line	:	1301 S FERN ST UNIT 25351
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-5964
Country	:	US
Telephone Number	:	571-969-5264
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 17TH ST S
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-2602
Country	:	US
Telephone Number	:	571-969-5264
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	MS. KAMARIA ARIEL SIDMAN
Credential	:
Telephone Number	:	571-969-5264

Provider Enumeration Date	:	09/19/2021
Last Update Date	:	09/19/2021

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