| Mental Health Therapy Center - Northern Virginia, Llc | |
|
10721 Main St Ste 1300 Fairfax VA 22030-6902 | |
| (703) 536-2000 | |
| Not Available |
| Full Name | Mental Health Therapy Center - Northern Virginia, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 10721 Main St Ste 1300, Fairfax, Virginia |
| Authorized Official Name and Position | Mike Gingras (DIVISION CFO) |
| Authorized Official Contact | 8042284901 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mental Health Therapy Center - Northern Virginia, Llc 10721 Main St Ste 1300 Fairfax VA 22030-6902 Ph: () - | Mental Health Therapy Center - Northern Virginia, Llc 10721 Main St Ste 1300 Fairfax VA 22030-6902 Ph: (703) 536-2000 |
| NPI Number | 1194566117 |
|---|---|
| Provider Enumeration Date | 06/04/2024 |
| Last Update Date | 06/04/2024 |
| Certification Date | 06/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194566117 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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