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Organization
DIETETIC CONSULTANTS OF NORTHERN VIRGINIA, LLC
Active
Organization
DIETETIC CONSULTANTS OF NORTHERN VIRGINIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BONITA LILLIE RD, LD (PRESIDENT)
(703) 879-5160
Entity
Organization
Contact information
Practice address
2121 EISENHOWER AVE, SUITE 200, ALEXANDRIA, VA 22314-4698
(703) 519-0901
(703) 519-0902
Mailing address
5412 CASTLE BAR LN, ALEXANDRIA, VA 22315-5519
(703) 879-5160
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2004009119
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G02785
MEDICARE PTAN
—
Enumeration date
11/07/2007
Last updated
09/18/2008
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