# 360 INNOVATIVE THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** 360 Innovative Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770178816
- **Authorized official:** BEVERLY MCNAIRY ED.M. (CEO)
- **Authorized official phone:** (571) 575-3767

## Contact information

- **Practice address:** 10304 EATON PL STE 100, FAIRFAX, VA 22030-2238
- **Practice address phone:** (571) 575-3767
- **Practice address fax:** (877) 525-1222
- **Mailing address:** 10304 EATON PL STE 100, FAIRFAX, VA 22030-2238
- **Mailing address phone:** (571) 575-3767
- **Mailing address fax:** (877) 525-1222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YS0200X | School Counselor | — | NULL | — |
| 101YS0200X | School Counselor | — | — | — |

## Other

- **Enumeration date:** 03/01/2021
- **Last updated:** 03/01/2021