Provider Demographics
NPI:1417392747
Name:GIL INSTITUTE FOR TRAUMA RECOVERY AND EDUCATION, LLC
Entity type:Organization
Organization Name:GIL INSTITUTE FOR TRAUMA RECOVERY AND EDUCATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER /THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:GOLDIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW RPT
Authorized Official - Phone:703-560-2600
Mailing Address - Street 1:8626 LEE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2135
Mailing Address - Country:US
Mailing Address - Phone:703-560-2600
Mailing Address - Fax:703-560-2622
Practice Address - Street 1:8626 LEE HWY STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2135
Practice Address - Country:US
Practice Address - Phone:703-560-2600
Practice Address - Fax:703-560-2622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIL INSTITUTE FOR TRAUMA RECOVERY AND EDUCATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040056261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty