Provider Demographics
NPI:1558415968
Name:NATIONAL CAPITAL TREATMENT AND RECOVERY
Entity Type:Organization
Organization Name:NATIONAL CAPITAL TREATMENT AND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-825-8762
Mailing Address - Street 1:200 N GLEBE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-3755
Mailing Address - Country:US
Mailing Address - Phone:703-841-0703
Mailing Address - Fax:703-243-0975
Practice Address - Street 1:521 N. QUINCY STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-841-0703
Practice Address - Fax:703-243-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA122-02-001101YA0400X
VA122-07-004101YA0400X
208D00000X, 363LP2300X
VA122323P00000X
VA122-01-006324500000X
VA122-01-007324500000X
VA122-01-11324500000X
VA122-14-003324500000X
VA122-14-001324500000X
VA122-14-002324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NX5OtherCAREFIRST
003005OtherMULTIPLAN
VA004945051Medicaid
092312OtherVALUE OPTIONS