Provider Demographics
NPI:1194919035
Name:AL NESTOR
Entity type:Organization
Organization Name:AL NESTOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:NESTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-922-0443
Mailing Address - Street 1:6092 FRANCONIA RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1741
Mailing Address - Country:US
Mailing Address - Phone:703-922-0443
Mailing Address - Fax:703-922-0603
Practice Address - Street 1:6092 FRANCONIA RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-1741
Practice Address - Country:US
Practice Address - Phone:703-922-0443
Practice Address - Fax:703-922-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040000571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00604Medicare PIN