Provider Demographics
NPI:1275054033
Name:SALUS VITA
Entity Type:Organization
Organization Name:SALUS VITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ LEAD THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW/ LCSW
Authorized Official - Phone:703-828-7159
Mailing Address - Street 1:505 WYTHE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1917
Mailing Address - Country:US
Mailing Address - Phone:703-828-7159
Mailing Address - Fax:
Practice Address - Street 1:505 WYTHE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1917
Practice Address - Country:US
Practice Address - Phone:703-828-7159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-02
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904009738261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)