Provider Demographics
NPI:1245789460
Name:NOVA ADDICTION SPECIALISTS LLLC
Entity Type:Organization
Organization Name:NOVA ADDICTION SPECIALISTS LLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-340-1304
Mailing Address - Street 1:101 N COLUMBUS ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3056
Mailing Address - Country:US
Mailing Address - Phone:703-340-1304
Mailing Address - Fax:888-965-7708
Practice Address - Street 1:101 N COLUMBUS ST
Practice Address - Street 2:SUITE 405
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3056
Practice Address - Country:US
Practice Address - Phone:703-340-1304
Practice Address - Fax:888-965-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty