| Rule 62 Therapy Llc | |
|
14117 Mariah Ct Chantilly VA 20151-2113 | |
| (571) 210-0355 | |
| Not Available |
| Full Name | Rule 62 Therapy Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 14117 Mariah Ct, Chantilly, Virginia |
| Authorized Official Name and Position | Samuel Kim (CLINICAL DIRECTOR/PSYCHOTHERAPIST) |
| Authorized Official Contact | 5715202013 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rule 62 Therapy Llc 14117 Mariah Ct Chantilly VA 20151-2113 Ph: (571) 520-2013 | Rule 62 Therapy Llc 14117 Mariah Ct Chantilly VA 20151-2113 Ph: (571) 210-0355 |
| NPI Number | 1942073127 |
|---|---|
| Provider Enumeration Date | 10/31/2023 |
| Last Update Date | 05/18/2024 |
| Certification Date | 05/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942073127 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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