| Ladderbox, Llc | |
|
4252 Airline Pkwy Chantilly VA 20151-3968 | |
| (202) 655-7138 | |
| Not Available |
| Full Name | Ladderbox, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4252 Airline Pkwy, Chantilly, Virginia |
| Authorized Official Name and Position | Jillian Antoinette Theryon (PSYCHOTHERAPIST) |
| Authorized Official Contact | 2026557138 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ladderbox, Llc 4252 Airline Pkwy Chantilly VA 20151-3968 Ph: (202) 655-7138 | Ladderbox, Llc 4252 Airline Pkwy Chantilly VA 20151-3968 Ph: (202) 655-7138 |
| NPI Number | 1063107696 |
|---|---|
| Provider Enumeration Date | 04/10/2023 |
| Last Update Date | 04/10/2023 |
| Certification Date | 04/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063107696 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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