| Holistic Psychiatry And Medical Center Llc | |
|
556 Garrisonville Rd Ste 210 Stafford VA 22554-7819 | |
| (301) 917-5808 | |
| (571) 774-4123 |
| Full Name | Holistic Psychiatry And Medical Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 556 Garrisonville Rd Ste 210, Stafford, Virginia |
| Authorized Official Name and Position | Doris Cudjoe Owusu (OWNER) |
| Authorized Official Contact | 5713153313 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holistic Psychiatry And Medical Center Llc 214 Determination Dr Stafford VA 22554-3366 Ph: (301) 917-5808 | Holistic Psychiatry And Medical Center Llc 556 Garrisonville Rd Ste 210 Stafford VA 22554-7819 Ph: (301) 917-5808 |
| NPI Number | 1184393159 |
|---|---|
| Provider Enumeration Date | 09/12/2021 |
| Last Update Date | 12/05/2023 |
| Certification Date | 12/05/2023 |
| Medicare PECOS PAC ID | 9931599461 |
|---|---|
| Medicare Enrollment ID | O20211124000197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184393159 | NPI | - | NPPES |
| Provider Name | Doris Cudjoe Owusu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780287607 PECOS PAC ID: 7810396686 Enrollment ID: I20210527000722 |
| Provider Name | Alice Sesay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811751605 PECOS PAC ID: 8224479431 Enrollment ID: I20240517002607 |
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