Organization
PRINCE WILLIAM COUNTY EARLY INTERVENTION PROGRAM
Active
Parent organization
PRINCE WILLIAM COUNTY COMMUNITY SERVICES BOARD
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRINCE WILLIAM COUNTY COMMUNITY SERVICES BOARD
Authorized official
LISA MADRON (EXECUTIVE DIRECTOR)
(703) 792-7800
Entity
Organization
Contact information
Practice address
7969 ASHTON AVE, MANASSAS, VA 20109-2885
(703) 792-7800
(703) 792-5699
Mailing address
7969 ASHTON AVE, MANASSAS, VA 20109-2885
(703) 792-7800
(703) 792-5699
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004978277
—
VA
01
—
187835
ANTHEM BLUE CROSS BLUE SH
VA
01
—
187839
ANTHEM BLUE CROSS BLUE SH
VA
01
—
187840
ANTHEM BLUE CROSS BLUE SH
VA
Enumeration date
07/11/2007
Last updated
04/11/2025
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