Provider Demographics
NPI:1053904227
Name:REEMERGE CHILD THERAPY
Entity type:Organization
Organization Name:REEMERGE CHILD THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORDSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-491-4300
Mailing Address - Street 1:24 ASHBY STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-491-4300
Mailing Address - Fax:
Practice Address - Street 1:24 ASHBY STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186
Practice Address - Country:US
Practice Address - Phone:540-491-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health