Provider Demographics
NPI:1215163506
Name:GROUP THERAPY ASSOCIATES
Entity type:Organization
Organization Name:GROUP THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:571-235-0714
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20168-0127
Mailing Address - Country:US
Mailing Address - Phone:703-644-8041
Mailing Address - Fax:703-644-8041
Practice Address - Street 1:15175 WASHINGTON ST
Practice Address - Street 2:SUITE 302A
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2951
Practice Address - Country:US
Practice Address - Phone:703-644-8041
Practice Address - Fax:703-644-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1104938612101YP2500X
VA0717001145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty