Provider Demographics
NPI:1396388930
Name:AQUILA RECOVERY OF VIRGINIA LLC
Entity Type:Organization
Organization Name:AQUILA RECOVERY OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-464-5122
Mailing Address - Street 1:425 CARLISLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5618
Mailing Address - Country:US
Mailing Address - Phone:703-464-5122
Mailing Address - Fax:
Practice Address - Street 1:425 CARLISLE DR STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5618
Practice Address - Country:US
Practice Address - Phone:703-464-5122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty