Provider Demographics
NPI:1568965333
Name:BARNES, WILLIAM HENRY
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 PLANTATION PKWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2118
Mailing Address - Country:US
Mailing Address - Phone:240-462-0302
Mailing Address - Fax:
Practice Address - Street 1:3112 PLANTATION PKWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2118
Practice Address - Country:US
Practice Address - Phone:240-462-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities