Provider Demographics
NPI:1124588751
Name:SEVEN CORNERS PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:SEVEN CORNERS PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GLACEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:571-329-7077
Mailing Address - Street 1:6059B ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2721
Mailing Address - Country:US
Mailing Address - Phone:571-329-7077
Mailing Address - Fax:
Practice Address - Street 1:6059B ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2721
Practice Address - Country:US
Practice Address - Phone:571-329-7077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty