| Clementine Twin Lakes, Llc | |
|
11329 Henderson Rd Fairfax Station VA 22039-2314 | |
| (305) 663-1876 | |
| Not Available |
| Full Name | Clementine Twin Lakes, Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 11329 Henderson Rd, Fairfax Station, Virginia |
| Authorized Official Name and Position | Mike Bagley (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3056631876 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clementine Twin Lakes, Llc 6100 Sw 76th St South Miami FL 33143-5002 Ph: (305) 663-1876 | Clementine Twin Lakes, Llc 11329 Henderson Rd Fairfax Station VA 22039-2314 Ph: (305) 663-1876 |
| NPI Number | 1689269250 |
|---|---|
| Provider Enumeration Date | 03/05/2021 |
| Last Update Date | 03/05/2021 |
| Certification Date | 03/05/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689269250 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
Northern Virginia Aba Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9508 Quail Pointe Ln, Fairfax Station, VA 22039 Phone: 571-334-2375 | |
Safe In Zion Autism Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10710 Shadowglen Trl, Fairfax Station, VA 22039 Phone: 703-457-1047 | |
Clinical Therapy Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9405 Larkdale Ter, Fairfax Station, VA 22039 Phone: 703-581-7863 | |
Tender Touch Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10710 Shadowglen Trl, Fairfax Station, VA 22039 Phone: 703-655-7738 |