|
| |
|
14500 Avion Pkwy Ste 315 Chantilly VA 20151-1108 | |
| (703) 260-9978 | |
| (703) 890-2554 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 14500 Avion Pkwy Ste 315, Chantilly, Virginia |
| Authorized Official Name and Position | Stephanie L Afshar (OWNER) |
| Authorized Official Contact | 7038691468 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
14500 Avion Pkwy Ste 315 Chantilly VA 20151-1108 Ph: (703) 260-9978 | 14500 Avion Pkwy Ste 315 Chantilly VA 20151-1108 Ph: (703) 260-9978 |
| NPI Number | 1629787809 |
|---|---|
| Provider Enumeration Date | 11/16/2022 |
| Last Update Date | 09/27/2024 |
| Certification Date | 09/27/2024 |
| Medicare PECOS PAC ID | 1355876749 |
|---|---|
| Medicare Enrollment ID | O20241121003314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629787809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kristine Pantke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033830492 PECOS PAC ID: 4284005778 Enrollment ID: I20230811000277 |
| Provider Name | Amanda Leigh Davis-scott |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568977874 PECOS PAC ID: 2961853577 Enrollment ID: I20240109000224 |
Connections Medical Of Va, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 14554 Lee Rd Ste 102, Chantilly, VA 20151 Phone: 520-301-2400 | |
Ladderbox, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4252 Airline Pkwy, Chantilly, VA 20151 Phone: 202-655-7138 | |
Connections Healthva, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 14554 Lee Rd Ste 101, Chantilly, VA 20151 Phone: 520-301-2400 | |
David C Heebner, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 14143 Robert Paris Ct, Chantilly, VA 20151 Phone: 703-403-2773 | |
Psychiatric Associates Of Northern Virginia Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4229 Lafayette Center Dr Ste 1760, Chantilly, VA 20151 Phone: 443-610-2615 | |