Provider Demographics
NPI:1790204097
Name:HEAVENLY BODIES CLINIC
Entity Type:Organization
Organization Name:HEAVENLY BODIES CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DAS, BOARD CER
Authorized Official - Phone:703-528-8272
Mailing Address - Street 1:1305 N EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-2600
Mailing Address - Country:US
Mailing Address - Phone:703-528-8272
Mailing Address - Fax:
Practice Address - Street 1:1305 N EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-2600
Practice Address - Country:US
Practice Address - Phone:703-528-8272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000225171100000X
CTCT-0000004171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty