Provider Demographics
NPI:1407974843
Name:DIVORCE AND MARITAL STRESS CLINIC INC
Entity Type:Organization
Organization Name:DIVORCE AND MARITAL STRESS CLINIC INC
Other - Org Name:KEY BRIDGE THERAPY AND MEDIATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW MSW
Authorized Official - Phone:703-528-3900
Mailing Address - Street 1:1600 WILSON BLVD
Mailing Address - Street 2:SUITE 702
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2505
Mailing Address - Country:US
Mailing Address - Phone:703-528-3900
Mailing Address - Fax:703-524-7525
Practice Address - Street 1:1600 WILSON BLVD
Practice Address - Street 2:SUITE 702
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2505
Practice Address - Country:US
Practice Address - Phone:703-528-3900
Practice Address - Fax:703-524-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040008341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty