Provider Demographics
NPI:1770640237
Name:FAMILY THERAPY ASSOCIATES OF ALEXANDRIA INC
Entity Type:Organization
Organization Name:FAMILY THERAPY ASSOCIATES OF ALEXANDRIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - ADMIN & FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:FAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-837-8808
Mailing Address - Street 1:201 N FAIRFAX ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2639
Mailing Address - Country:US
Mailing Address - Phone:703-837-8808
Mailing Address - Fax:703-837-8805
Practice Address - Street 1:201 N FAIRFAX ST
Practice Address - Street 2:SUITE 22
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2639
Practice Address - Country:US
Practice Address - Phone:703-837-8808
Practice Address - Fax:703-837-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040030161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty