Provider Demographics
NPI:1851092746
Name:GROWING KIDS THERAPY CENTER INC.
Entity Type:Organization
Organization Name:GROWING KIDS THERAPY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-464-0456
Mailing Address - Street 1:722 GRANT ST STE A
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4533
Mailing Address - Country:US
Mailing Address - Phone:703-464-0456
Mailing Address - Fax:
Practice Address - Street 1:722 GRANT ST STE A
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4533
Practice Address - Country:US
Practice Address - Phone:703-464-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center