Provider Demographics
NPI:1518388537
Name:FALLS CHURCH WELLNESS CENTER
Entity Type:Organization
Organization Name:FALLS CHURCH WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:LAMP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-888-3533
Mailing Address - Street 1:300 N WASHINGTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3438
Mailing Address - Country:US
Mailing Address - Phone:703-888-3533
Mailing Address - Fax:571-364-0075
Practice Address - Street 1:300 N WASHINGTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3438
Practice Address - Country:US
Practice Address - Phone:703-888-3533
Practice Address - Fax:571-364-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty