Provider Demographics
NPI:1003257726
Name:ALEXANDRIA ADOLESCENT AND ADULT THERAPY, INC.
Entity Type:Organization
Organization Name:ALEXANDRIA ADOLESCENT AND ADULT THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSOTP
Authorized Official - Phone:518-522-3628
Mailing Address - Street 1:8424 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2319
Mailing Address - Country:US
Mailing Address - Phone:518-522-3628
Mailing Address - Fax:571-312-9526
Practice Address - Street 1:228 S WASHINGTON ST
Practice Address - Street 2:SUITE 330
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-5408
Practice Address - Country:US
Practice Address - Phone:518-483-5002
Practice Address - Fax:571-312-9526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904007238251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health