Provider Demographics
NPI:1275565673
Name:VIRGINIA SUPPORT SERVICES, P.C.
Entity Type:Organization
Organization Name:VIRGINIA SUPPORT SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-367-7800
Mailing Address - Street 1:8140 ASHTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2894
Mailing Address - Country:US
Mailing Address - Phone:703-367-7800
Mailing Address - Fax:703-368-8454
Practice Address - Street 1:8140 ASHTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2894
Practice Address - Country:US
Practice Address - Phone:703-367-7800
Practice Address - Fax:703-368-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty