LIFE LINE ADDICTIONS FOUNDATION INC. (NPI# 1437223922) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437223922 |
| Entity Type | Organization |
| Organization Name | LIFE LINE ADDICTIONS FOUNDATION INC. |
| Other Organization Name | LIFE LINE COUNSELING CENTER |
| Practice Address |
10374 Democracy Ln Ste A Fairfax VA 22030-2557 |
| Mailing Address |
4308 Beaver Dam Rd Jeffersonton VA 22724-2001 |
| Practice Telephone | 7036913029 |
| Practice Fax Number | 7036917410 |
| Mailing Telephone | 5403479531 |
| Mailing Fax Number | 7036917410 |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. GEORGE LYNDON SWANBERG (PRESIDENT) |
| Authorized Official Telephone | 7036913029 |
| Authorized Official Credential | LCSW, LSATP, MAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
0718000188 | VA | Behavioral Health & Social Service Providers |
| X | 1041C0700X |
Social Worker Specialization: Clinical |
0904006265 | VA | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Life Line Counseling Center | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | LIFE LINE ADDICTIONS FOUNDATION INC. | 4308 Beaver Dam Rd, Jeffersonton, Virginia 22724 |
| Street Address |
10374 DEMOCRACY LN STE A |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-2557 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417469974 | Lifeline Psychotherapy Services | Counselor | 11350 Random Hills Rd Ste 800, Fairfax, VA 22030-6044 | 2017-10-24 |
| 1770959603 | Kimberley L Berlin | Counselor | 10640 Page Ave, Fairfax, VA 22030-4000 | 2015-08-14 |
| 1669852026 | Transitions...the Process of Change | Counselor | 8280 Willow Oaks Corporate Dr, Suite 600, Fairfax, VA 22031-4518 | 2015-06-01 |
| 1861724445 | Carolyn Elizabeth Kuchel | Counselor | 4505 Shirley Gate Rd, Fairfax, VA 22030-5522 | 2010-02-05 |
| 1982938361 | William Alberti Prasad | Counselor | 4100 Chain Bridge Rd, 6-121, Fairfax, VA 22030-7003 | 2009-10-01 |
| 1679736342 | Maria Christine Hadjiyane | Counselor | 3615 Chain Bridge Rd Unit I, Integrative Psychotherapy Institute, Fairfax, VA 22030 | 2008-07-03 |
| 1932121290 | Gail W Campbell | Counselor | 10390 Democracy Ln, Fairfax, VA 22030-2522 | 2006-07-24 |
| 1609898154 | David Alan Jacobs | Counselor | 3900 Jermantown Rd Ste 200, Fairfax, VA 22030-4900 | 2006-07-24 |
| 1053339929 | Roberta E Severo | Counselor | 3912 Pineland St, Fairfax, VA 22031-3321 | 2006-07-18 |
| 1407453442 | Vilma Gisell Gaitan Valdizan | Counselor | 8221 Willow Oaks Corporate Dr, Fairfax, VA 22031-4512 | 2020-10-02 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.