Provider Demographics
NPI:1992337141
Name:NOVA TERRA THERAPY PLC
Entity type:Organization
Organization Name:NOVA TERRA THERAPY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-868-8609
Mailing Address - Street 1:7807 S VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2971
Mailing Address - Country:US
Mailing Address - Phone:703-868-8609
Mailing Address - Fax:
Practice Address - Street 1:5213A LYNGATE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1698
Practice Address - Country:US
Practice Address - Phone:703-868-8609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health