| Mind Body Connections Llc | |
|
13380 Hudson Pl Bristow VA 20136-1708 | |
| (703) 753-9496 | |
| Not Available |
| Full Name | Mind Body Connections Llc |
|---|---|
| Speciality | Social Worker |
| Location | 13380 Hudson Pl, Bristow, Virginia |
| Authorized Official Name and Position | Nina L Mccormack (LCSW) |
| Authorized Official Contact | 7037059880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Body Connections Llc 13380 Hudson Pl Bristow VA 20136-1708 Ph: (703) 705-9880 | Mind Body Connections Llc 13380 Hudson Pl Bristow VA 20136-1708 Ph: (703) 753-9496 |
| NPI Number | 1750120762 |
|---|---|
| Provider Enumeration Date | 05/20/2024 |
| Last Update Date | 05/20/2024 |
| Certification Date | 05/20/2024 |
| Medicare PECOS PAC ID | 1052855210 |
|---|---|
| Medicare Enrollment ID | O20240628000093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750120762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Nina Luanne Mccormack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912092008 PECOS PAC ID: 6800149956 Enrollment ID: I20240628000312 |
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