| Restore Mental Health Services Llc | |
|
4000 Legato Rd Ste 1100 Fairfax VA 22033-2893 | |
| (571) 358-8692 | |
| Not Available |
| Full Name | Restore Mental Health Services Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4000 Legato Rd Ste 1100, Fairfax, Virginia |
| Authorized Official Name and Position | Uchechi Anyalebechi (NURSE PRACTITIONER) |
| Authorized Official Contact | 5713588692 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Restore Mental Health Services Llc 4000 Legato Rd Ste 1100 Fairfax VA 22033-2893 Ph: () - | Restore Mental Health Services Llc 4000 Legato Rd Ste 1100 Fairfax VA 22033-2893 Ph: (571) 358-8692 |
| NPI Number | 1871219972 |
|---|---|
| Provider Enumeration Date | 10/19/2022 |
| Last Update Date | 10/19/2022 |
| Certification Date | 10/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871219972 | NPI | - | NPPES |
| 15013327 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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