| Aquila Recovery Of Virginia Llc | |
|
425 Carlisle Dr Ste B Herndon VA 20170-5618 | |
| (703) 464-5122 | |
| Not Available |
| Full Name | Aquila Recovery Of Virginia Llc |
|---|---|
| Speciality | Counselor |
| Location | 425 Carlisle Dr Ste B, Herndon, Virginia |
| Authorized Official Name and Position | Robert R Coffey (OWNER) |
| Authorized Official Contact | 7034645122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aquila Recovery Of Virginia Llc 425 Carlisle Dr Ste B Herndon VA 20170-5618 Ph: (703) 464-5122 | Aquila Recovery Of Virginia Llc 425 Carlisle Dr Ste B Herndon VA 20170-5618 Ph: (703) 464-5122 |
| NPI Number | 1396388930 |
|---|---|
| Provider Enumeration Date | 10/28/2019 |
| Last Update Date | 10/28/2019 |
| Medicare PECOS PAC ID | 5991102295 |
|---|---|
| Medicare Enrollment ID | O20210929003354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396388930 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Larry H Pastor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114095981 PECOS PAC ID: 8921272980 Enrollment ID: I20111201000239 |
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