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2235 Cedar Ln Ste 102 Vienna VA 22182-5247 | |
| (703) 556-4888 | |
| (703) 556-7774 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 2235 Cedar Ln Ste 102, Vienna, Virginia |
| Authorized Official Name and Position | Shahrzad Poorshaghaghi (OWNER) |
| Authorized Official Contact | 7035564888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2235 Cedar Ln Ste 102 Vienna VA 22182-5247 Ph: (703) 556-4888 | 2235 Cedar Ln Ste 102 Vienna VA 22182-5247 Ph: (703) 556-4888 |
| NPI Number | 1740386762 |
|---|---|
| Provider Enumeration Date | 09/16/2006 |
| Last Update Date | 10/18/2022 |
| Certification Date | 10/18/2022 |
| Medicare PECOS PAC ID | 0941363956 |
|---|---|
| Medicare Enrollment ID | O20240909003702 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740386762 | NPI | - | NPPES |
| 005411165 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 0701002934 (Virginia) | Primary |
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| Provider Name | Shahrzad Poorshaghaghi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437171337 PECOS PAC ID: 7618031477 Enrollment ID: I20240909003827 |
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