Provider Demographics
NPI:1598306649
Name:CATALYST RECOVERY AND WELLNESS LLC
Entity Type:Organization
Organization Name:CATALYST RECOVERY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-546-1834
Mailing Address - Street 1:9309 CENTER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5599
Mailing Address - Country:US
Mailing Address - Phone:703-546-1834
Mailing Address - Fax:571-336-5464
Practice Address - Street 1:9309 CENTER ST STE 101
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5599
Practice Address - Country:US
Practice Address - Phone:703-546-1834
Practice Address - Fax:571-336-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder