Organization
TAVAZON PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS KIRBY (ADMINISTRATOR)
(301) 651-3980
Entity
Organization
Contact information
Practice address
2960 SLEEPY HOLLOW RD, FALLS CHURCH, VA 22044
(571) 455-8006
Mailing address
46179 WESTLAKE DRIVE, SUITE 250, STERLING, VA 20165
(571) 455-8006
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
0101238065
VA
305R00000X
Preferred Provider Organization
0101238065
VA
305S00000X
Point of Service
0101238065
VA
Other
Enumeration date
09/29/2012
Last updated
04/17/2023
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