Provider Demographics
NPI:1790178713
Name:CLINICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:CLINICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDIPENDENT CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:X
Authorized Official - Credentials:LCSW-C,
Authorized Official - Phone:703-581-7863
Mailing Address - Street 1:9405 LARKDALE TER
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3136
Mailing Address - Country:US
Mailing Address - Phone:703-581-7863
Mailing Address - Fax:703-581-7863
Practice Address - Street 1:9405 LARKDALE TER
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-3136
Practice Address - Country:US
Practice Address - Phone:703-581-7863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003799251S00000X
MD10522251S00000X
DCLC303400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health