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 |
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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 |
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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 |
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Provider Enumeration Date | 10/28/2019 |
Last Update Date | 10/28/2019 |
Medicare PECOS PAC ID | 5991102295 |
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Medicare Enrollment ID | O20210929003354 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396388930 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
Provider Name | Larry H Pastor |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1114095981 PECOS PAC ID: 8921272980 Enrollment ID: I20111201000239 |
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