Organization
TRURO CHURCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIM TEAGUE (DIRECTOR)
(703) 273-1300
Entity
Organization
Contact information
Practice address
10520 MAIN ST, FAIRFAX, VA 22030-3304
(703) 273-1300
Mailing address
10520 MAIN ST, FAIRFAX, VA 22030-3304
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
0701001459
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0701001459
PROFESSIONAL COUNSELOR
VA
Enumeration date
02/13/2007
Last updated
08/22/2020
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