Provider Demographics
NPI:1518469246
Name:MARRIAGE HEALING CENTER, LLC
Entity Type:Organization
Organization Name:MARRIAGE HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:571-699-0160
Mailing Address - Street 1:7230 HERITAGE VILLAGE PLZ STE 202
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3054
Mailing Address - Country:US
Mailing Address - Phone:571-480-1991
Mailing Address - Fax:
Practice Address - Street 1:7230 HERITAGE VILLAGE PLZ STE 202
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3054
Practice Address - Country:US
Practice Address - Phone:571-480-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty