Old Town Therapy & Wellness Center, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904005550 Issued in VA

Legal business name

OLD TOWN THERAPY & WELLNESS CENTER, LLC

Practice address

6119 Holly Tree Dr
Alexandria, VA 22310-2215

Phone

(703) 577-5550

NPI assigned

Mar 6, 2013

Last updated

Mar 6, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Ross, LCSWNPI 1972835072

Title

Director

Phone

(703) 577-5550

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan Ross, LCSW

  • Clinical Social Worker
  • Alexandria, VA
  • NPI 1972835072
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362528000000",
    "number": "1760723423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 KING ST STE 203A",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223143016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6119 HOLLY TREE DR",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223102215",
            "telephone_number": "703-577-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN THERAPY & WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-06",
        "last_updated": "2013-03-06",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "703-577-5550",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904005550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Old Town Dental Partners (Nova Dental Partners)
• Old Town Dental Partners, PC (Nova Dental Partners)
• Old Town Professional Psychology
• Old Town Psychology
• Old Town Psychotherapy
• Old Towne Chiropractic Services LTD (Old Towne Chiropractic Services)
• Olde Towne Obstetrics & Gynecology, LLC
• Andrea Olguin
• Sophia Susana Olguin
• Nasia Olinger, DPT

• Clinical Social Worker in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.