360 Innovative Therapy LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

360 INNOVATIVE THERAPY LLC

Doing business as

360 Innovative Therapy

Practice address

10304 Eaton PL Ste 100
Fairfax, VA 22030-2238

Phone

(571) 575-3767

Fax

(877) 525-1222

NPI assigned

Mar 1, 2021

Last updated

Mar 1, 2021By 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

Beverly McNairy, ED.M.NPI 1386377653

Title

Ceo

Phone

(571) 575-3767

Specialties & licenses 4

Addresses

Other names 1

• 360 Innovative Therapy Doing business as

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.

• Beverly McNairy, LPC

  • Professional Counselor
  • Fairfax, VA
  • NPI 1386377653

  Addiction (Substance Use Disorder)

  NPD Authorized official

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

{
    "created_epoch": "1614556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614556800000",
    "number": "1770178816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10304 EATON PL STE 100",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302238",
            "telephone_number": "571-575-3767",
            "fax_number": "877-525-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10304 EATON PL STE 100",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302238",
            "telephone_number": "571-575-3767",
            "fax_number": "877-525-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "360 INNOVATIVE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-01",
        "last_updated": "2021-03-01",
        "certification_date": "2021-02-26",
        "status": "A",
        "authorized_official_last_name": "MCNAIRY",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "571-575-3767",
        "authorized_official_credential": "ED.M."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "360 Innovative Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Addiction (Substance Use Disorder) Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; 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.