| Ajk Tranquil Space | |
|
1376 Old Bridge Rd Ste 102 Woodbridge VA 22192-2766 | |
| (202) 207-4885 | |
| Not Available |
| Full Name | Ajk Tranquil Space |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1376 Old Bridge Rd Ste 102, Woodbridge, Virginia |
| Authorized Official Name and Position | Youssouf Kouyate (OFFICE MANAGER) |
| Authorized Official Contact | 2022074885 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ajk Tranquil Space 1376 Old Bridge Rd Woodbridge VA 22192-2762 Ph: (202) 207-4885 | Ajk Tranquil Space 1376 Old Bridge Rd Ste 102 Woodbridge VA 22192-2766 Ph: (202) 207-4885 |
| NPI Number | 1629830484 |
|---|---|
| Provider Enumeration Date | 01/26/2024 |
| Last Update Date | 01/26/2024 |
| Certification Date | 01/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629830484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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