Provider Demographics
NPI:1487030532
Name:TRAUMA AND HOPE
Entity Type:Organization
Organization Name:TRAUMA AND HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:CSOTP, LCSW
Authorized Official - Phone:571-366-0086
Mailing Address - Street 1:8317 BLUEBIRD WAY
Mailing Address - Street 2:UNIT K
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8317 BLUEBIRD WAY
Practice Address - Street 2:UNIT K
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-2844
Practice Address - Country:US
Practice Address - Phone:571-366-0086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904007859251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904007859OtherLICENSED CLINICAL SOCIAL WORKER
VA0812000610OtherCERTIFIED SEX OFFENDER TREATMENT PROFESSIONAL