Organization · NPI-2

360 Innovative Therapy LLC

Counselor, Addiction (Substance Use Disorder) · Fairfax, VA

NPI number1770178816
StatusActive
Last updated in NPPESMar 1, 2021

Details

NPI
1770178816
Entity type
Organization (NPI-2)
Legal business name
360 Innovative Therapy LLC
Organization subpart
No
Enumeration date
Mar 1, 2021
Certification date
Feb 26, 2021
Last updated
Mar 1, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YA0400X Counselor, Addiction (Substance Use Disorder)––Yes
101Y00000X Counselor––
101YM0800X Counselor, Mental Health––
101YS0200X Counselor, School––

Other names

  • 360 Innovative Therapy (Doing Business As)

Practice location

10304 Eaton Pl Ste 100
Fairfax, VA 22030-2238

Phone 571-575-3767 · Fax 877-525-1222

Mailing address

10304 Eaton Pl Ste 100
Fairfax, VA 22030-2238

Phone 571-575-3767 · Fax 877-525-1222

Authorized official

Beverly Mcnairy
Ceo
5715753767

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