49D2209043 CLIA NUMBER - COLLABORATIVE PAIN MANAGEMENT PLLC

Laboratory Demographics

  • CLIA Code: 49D2209043
  • Facility Name: COLLABORATIVE PAIN MANAGEMENT PLLC
  • Facility Address: 10400 EATON PLACE SUITE 312
    FAIRFAX, VA
    ZIP 22030
  • Facility Phone: (703) 261-6758
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MICHELLE M. JACQUES
  • NPI Number: 1356947295
  • Taxonomy: 208VP0000X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D2209043
LAB Type Practitioner Other
Facility Name COLLABORATIVE PAIN MANAGEMENT PLLC
Street 10400 EATON PLACE SUITE 312
City FAIRFAX
State VA
ZIP 22030
Phone 7032616758
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2025
Certificate Expiration Date 1/10/2027
Facility Type Practitioner Other
Lab Director MICHELLE M. JACQUES

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This page was last updated on: 5/18/2026