| Genesis Tms & Wellness Llc | |
|
10337b Democracy Ln Fairfax VA 22030-2521 | |
| (703) 955-0915 | |
| Not Available |
| Full Name | Genesis Tms & Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10337b Democracy Ln, Fairfax, Virginia |
| Authorized Official Name and Position | Ifeanyi M. Olele (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3102139945 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Tms & Wellness Llc 10337 Democracy Ln Ste B Fairfax VA 22030-2551 Ph: (703) 955-0915 | Genesis Tms & Wellness Llc 10337b Democracy Ln Fairfax VA 22030-2521 Ph: (703) 955-0915 |
| NPI Number | 1609545003 |
|---|---|
| Provider Enumeration Date | 09/09/2021 |
| Last Update Date | 07/27/2022 |
| Certification Date | 03/10/2022 |
| Medicare PECOS PAC ID | 0941694525 |
|---|---|
| Medicare Enrollment ID | O20220224001070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609545003 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Ifeanyi Olele |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194132407 PECOS PAC ID: 9133412794 Enrollment ID: I20170802000651 |
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