| Emerging For Change | |
|
11350 Random Hills Rd Ste 800 Fairfax VA 22030-6044 | |
| (703) 350-7752 | |
| Not Available |
| Full Name | Emerging For Change |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 11350 Random Hills Rd Ste 800, Fairfax, Virginia |
| Authorized Official Name and Position | Ericka Frizell Chandler (OWNER) |
| Authorized Official Contact | 7033507752 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Emerging For Change 108 N Gordon St Alexandria VA 22304-2406 Ph: (703) 350-7752 | Emerging For Change 11350 Random Hills Rd Ste 800 Fairfax VA 22030-6044 Ph: (703) 350-7752 |
| NPI Number | 1902412695 |
|---|---|
| Provider Enumeration Date | 09/18/2020 |
| Last Update Date | 09/18/2020 |
| Certification Date | 09/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902412695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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