Provider Demographics
NPI:1720553878
Name:ALIVE REHAB & COUNSELING LLC
Entity Type:Organization
Organization Name:ALIVE REHAB & COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-646-8806
Mailing Address - Street 1:500 N WASHINGTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2314
Mailing Address - Country:US
Mailing Address - Phone:703-646-8806
Mailing Address - Fax:703-570-5177
Practice Address - Street 1:500 N WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2314
Practice Address - Country:US
Practice Address - Phone:703-646-8806
Practice Address - Fax:703-570-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215465604OtherINDIVIDUAL NPI