Provider Demographics
NPI:1497185680
Name:THERAPEUTIC ALLIANCE LLC
Entity Type:Organization
Organization Name:THERAPEUTIC ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-492-2686
Mailing Address - Street 1:PO BOX 71807
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23255-1807
Mailing Address - Country:US
Mailing Address - Phone:877-794-2284
Mailing Address - Fax:804-612-5201
Practice Address - Street 1:7771 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2879
Practice Address - Country:US
Practice Address - Phone:703-492-2686
Practice Address - Fax:866-499-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004701251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA154005001Medicaid