OrganizationActive
360 Innovative Therapy LLC
NPI 1770178816 · Addiction (Substance Use Disorder) Counselor · Fairfax, VA
Provider details
- NPI number
- 1770178816
- Entity type
- Organization
- Primary specialty
- Addiction (Substance Use Disorder) CounselorBehavioral Health & Social Service Providers
- Authorized official
- Beverly Mcnairy, Ceo
Practice location
10304 Eaton Pl Ste 100
Fairfax, VA 22030-2238
Phone: (571) 575-3767
Fax: (877) 525-1222
Mailing address
10304 Eaton Pl Ste 100
Fairfax, VA 22030-2238
Registry dates
- Enumerated
- 2021-03-01
- Last updated
- 2021-03-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.