Provider Demographics
NPI:1558661231
Name:MOUNT VERNON FAMILY THERAPY ASSOC. LLC
Entity Type:Organization
Organization Name:MOUNT VERNON FAMILY THERAPY ASSOC. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:BRAMMER
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:703-768-6240
Mailing Address - Street 1:1707 BELLE VIEW BLVD
Mailing Address - Street 2:C-2
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6727
Mailing Address - Country:US
Mailing Address - Phone:703-768-6240
Mailing Address - Fax:703-768-6264
Practice Address - Street 1:1707 BELLE VIEW BLVD
Practice Address - Street 2:C-2
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6727
Practice Address - Country:US
Practice Address - Phone:703-768-6240
Practice Address - Fax:703-768-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001872101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty