Provider Demographics
NPI:1619059789
Name:NORTHERN VIRGINIA FAMILY SERVICE
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA FAMILY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, INTENSIVE FAMILY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:703-219-2125
Mailing Address - Street 1:10455 WHITE GRANITE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2764
Mailing Address - Country:US
Mailing Address - Phone:703-219-2166
Mailing Address - Fax:703-385-6181
Practice Address - Street 1:10455 WHITE GRANITE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2764
Practice Address - Country:US
Practice Address - Phone:703-219-2166
Practice Address - Fax:703-385-6181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VACO-20-06251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000200051Medicaid
VA000200051Medicaid