| Lasting Serenity Telepsychiatry Inc | |
|
8665 Sudley Rd # 228 Manassas VA 20110-4588 | |
| (571) 308-8243 | |
| Not Available |
| Full Name | Lasting Serenity Telepsychiatry Inc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 8665 Sudley Rd # 228, Manassas, Virginia |
| Authorized Official Name and Position | Lartoniah Hassan (PRESIDENT) |
| Authorized Official Contact | 3017929477 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lasting Serenity Telepsychiatry Inc 8665 Sudley Rd # 228 Manassas VA 20110-4588 Ph: (571) 308-8243 | Lasting Serenity Telepsychiatry Inc 8665 Sudley Rd # 228 Manassas VA 20110-4588 Ph: (571) 308-8243 |
| NPI Number | 1285396366 |
|---|---|
| Provider Enumeration Date | 10/06/2021 |
| Last Update Date | 09/07/2022 |
| Certification Date | 08/19/2022 |
| Medicare PECOS PAC ID | 3274923644 |
|---|---|
| Medicare Enrollment ID | O20211130001057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285396366 | NPI | - | NPPES |
| Provider Name | Lartoniah Hassan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790150258 PECOS PAC ID: 4486940178 Enrollment ID: I20211130001137 |
| Provider Name | Tiffany M Timm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902510829 PECOS PAC ID: 1052767316 Enrollment ID: I20231102002177 |
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