Provider Demographics
NPI:1730494329
Name:CHOSEN ONE THERAPIES, INC
Entity Type:Organization
Organization Name:CHOSEN ONE THERAPIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENIECE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MS-SLP, MED
Authorized Official - Phone:571-330-8120
Mailing Address - Street 1:17775 MAIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2491
Mailing Address - Country:US
Mailing Address - Phone:540-693-6997
Mailing Address - Fax:877-771-3419
Practice Address - Street 1:10851 TIDEWATER TRIAL
Practice Address - Street 2:#103
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-0260
Practice Address - Country:US
Practice Address - Phone:571-330-8120
Practice Address - Fax:877-771-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730494329Medicaid
VAC10948OtherGROUP PROVIDER (PTAN)
VA1073788931Medicaid