Organization
ADOLESCENT AND FAMILY GROWTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERMAINE H. JOHNSON MS, MFT (EXECUTIVE DIRECTOR)
(703) 425-9200
Entity
Organization
Contact information
Practice address
8000 FORBES PL, SUITE 201, SPRINGFIELD, VA 22151-2200
(703) 425-9200
(703) 425-9206
Mailing address
8000 FORBES PL, SUITE 201, SPRINGFIELD, VA 22151-2200
(703) 425-9200
(703) 425-9206
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
24203001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000200191
—
VA
Enumeration date
02/07/2007
Last updated
08/02/2012
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