| Mindful Athletes | |
|
12569 Plymouth Ct Woodbridge VA 22192-2349 | |
| (703) 220-0037 | |
| Not Available |
| Full Name | Mindful Athletes |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 12569 Plymouth Ct, Woodbridge, Virginia |
| Authorized Official Name and Position | Kailyn Rae Slade (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 7032200037 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Athletes 12569 Plymouth Ct Woodbridge VA 22192-2349 Ph: (703) 220-0037 | Mindful Athletes 12569 Plymouth Ct Woodbridge VA 22192-2349 Ph: (703) 220-0037 |
| NPI Number | 1467104844 |
|---|---|
| Provider Enumeration Date | 01/26/2022 |
| Last Update Date | 01/26/2022 |
| Certification Date | 01/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467104844 | NPI | - | NPPES |
| 2123 | Other | VA | ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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