Provider Demographics
NPI:1912269812
Name:SEASONS OF HOPE CENTER FOR GRIEF, LOSS AND TRANSITION
Entity Type:Organization
Organization Name:SEASONS OF HOPE CENTER FOR GRIEF, LOSS AND TRANSITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEISS-BRAUNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-447-8056
Mailing Address - Street 1:2805 MT. AIRY CT.
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1208
Mailing Address - Country:US
Mailing Address - Phone:703-283-6307
Mailing Address - Fax:703-492-1938
Practice Address - Street 1:2805 MOUNT AIRY CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-1208
Practice Address - Country:US
Practice Address - Phone:703-283-6307
Practice Address - Fax:703-492-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044751041C0700X
MD056321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2012034019Medicaid