Organization
NORTHERN VIRGINIA OLDER ADULT COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN M JOHNSON (PARTNER/OPERATIONS OFFICER)
(703) 424-0410
Entity
Organization
Contact information
Practice address
4700 BANTING CT, FAIRFAX, VA 22032-2451
(703) 424-0410
Mailing address
4700 BANTING CT, FAIRFAX, VA 22032-2451
(703) 424-0410
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0904006279
VA
Other
Enumeration date
10/03/2015
Last updated
02/04/2016
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