Provider Demographics
NPI:1659837821
Name:CAVERY TREATMENT CENTER
Entity type:Organization
Organization Name:CAVERY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARSHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:571-408-6800
Mailing Address - Street 1:14610 SULKY RUN CT
Mailing Address - Street 2:
Mailing Address - City:NOKESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20181-2953
Mailing Address - Country:US
Mailing Address - Phone:910-525-8017
Mailing Address - Fax:
Practice Address - Street 1:14330 GIDEON DR STE B
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4640
Practice Address - Country:US
Practice Address - Phone:571-408-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750665196OtherFNP-C