Provider Demographics
NPI:1992164834
Name:PSYCHOLOGICAL AND LIFE SKILLS ASSOCIATION
Entity type:Organization
Organization Name:PSYCHOLOGICAL AND LIFE SKILLS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:YARBOROUGH
Authorized Official - Last Name:TAFT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:571-285-1403
Mailing Address - Street 1:601 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4564
Mailing Address - Country:US
Mailing Address - Phone:703-490-0336
Mailing Address - Fax:
Practice Address - Street 1:601 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4564
Practice Address - Country:US
Practice Address - Phone:703-490-0336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-21
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040092601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty