Organization
INDEPENDENCE EMPOWERMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY D LOPEZ PH.D (EXECUTIVE DIRECTOR)
(703) 257-5400
Entity
Organization
Contact information
Practice address
8409 DORSEY CIR, SUITE # 101-102, MANASSAS, VA 20110-8305
(703) 257-5400
(703) 257-5043
Mailing address
8409 DORSEY CIR, SUITE # 101-102, MANASSAS, VA 20110-8305
(703) 257-5400
(703) 257-5043
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0087405426
—
VA
Enumeration date
10/14/2015
Last updated
10/14/2015
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