Provider Demographics
NPI:1942781968
Name:BEST LIFE THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:BEST LIFE THERAPEUTIC SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:571-455-5206
Mailing Address - Street 1:12909 CENTRE PARK CIR APT 408
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5848
Mailing Address - Country:US
Mailing Address - Phone:571-455-6596
Mailing Address - Fax:703-636-8983
Practice Address - Street 1:11250 ROGER BACON DR STE 15
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5202
Practice Address - Country:US
Practice Address - Phone:571-455-5206
Practice Address - Fax:703-636-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005958101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty