Provider Demographics
NPI:1730859885
Name:COMPASSIONATE THERAPY CENTER, LLC
Entity type:Organization
Organization Name:COMPASSIONATE THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MS
Authorized Official - First Name:KAMARIA
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:SIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-969-5264
Mailing Address - Street 1:1301 S FERN ST UNIT 25351
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-5964
Mailing Address - Country:US
Mailing Address - Phone:571-969-5264
Mailing Address - Fax:
Practice Address - Street 1:926 17TH ST S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2602
Practice Address - Country:US
Practice Address - Phone:571-969-5264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty