| Harris Integrative Training & Supervision, Llc | |
|
5413a Backlick Rd Springfield VA 22151-3915 | |
| (703) 256-1600 | |
| (703) 991-4878 |
| Full Name | Harris Integrative Training & Supervision, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5413a Backlick Rd, Springfield, Virginia |
| Authorized Official Name and Position | Laura E Thiemann (BILLING & CREDENTIALING MNAGER) |
| Authorized Official Contact | 5025108082 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Harris Integrative Training & Supervision, Llc 104 Saint Francis Ct Apt 26 Louisville KY 40205-1560 Ph: (502) 510-8082 | Harris Integrative Training & Supervision, Llc 5413a Backlick Rd Springfield VA 22151-3915 Ph: (703) 256-1600 |
| NPI Number | 1295310407 |
|---|---|
| Provider Enumeration Date | 03/10/2021 |
| Last Update Date | 03/10/2021 |
| Certification Date | 03/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295310407 | NPI | - | NPPES |
| 066770300 | Medicaid | MD | |
| 11752902 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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