Provider Demographics
NPI:1538408364
Name:STRESS CENTRE, INC.
Entity type:Organization
Organization Name:STRESS CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEGUNDA
Authorized Official - Middle Name:YANEX
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-392-6410
Mailing Address - Street 1:10529 CRESTWOOD DR
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4418
Mailing Address - Country:US
Mailing Address - Phone:703-392-6420
Mailing Address - Fax:703-392-6421
Practice Address - Street 1:10529 CRESTWOOD DR
Practice Address - Street 2:SUITE # 101
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4418
Practice Address - Country:US
Practice Address - Phone:703-392-6420
Practice Address - Fax:703-392-6421
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRESSCENTRE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000200106H00000X, 163WP0000X, 163WP0807X, 163WP0809X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty