1386937829 NPI number — CYCLELOGICAL CONNECTION INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386937829 NPI number — CYCLELOGICAL CONNECTION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYCLELOGICAL CONNECTION INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386937829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42979 GOLF VIEW DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CHANTILLY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20152-2006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-706-0996
Provider Business Mailing Address Fax Number:
571-248-0758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42979 GOLF VIEW DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CHANTILLY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20152-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-706-0996
Provider Business Practice Location Address Fax Number:
571-248-0758
Provider Enumeration Date:
05/17/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PITI
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
571-248-0757

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  0701004053 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)