Provider Demographics
NPI:1700285087
Name:NATIONAL CAPITAL TREATMENT AND RECOVERY
Entity Type:Organization
Organization Name:NATIONAL CAPITAL TREATMENT AND RECOVERY
Other - Org Name:COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT / DIRECTOR OF FINANC
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGREAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-841-0703
Mailing Address - Street 1:200 N GLEBE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-3728
Mailing Address - Country:US
Mailing Address - Phone:703-841-0703
Mailing Address - Fax:703-243-0975
Practice Address - Street 1:200 N GLEBE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-3728
Practice Address - Country:US
Practice Address - Phone:703-841-0703
Practice Address - Fax:703-243-0975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL CAPITAL TREATMENT AND RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-22
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA122-02-001, 021&004251S00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945051Medicaid
VA1558415968OtherNPI