| Riverside Mental And Medical Clinic | |
|
25 S Quaker Ln Suite 4 Alexandria VA 22314-4585 | |
| (571) 257-4398 | |
| (703) 823-4407 |
| Full Name | Riverside Mental And Medical Clinic |
|---|---|
| Speciality | Counselor |
| Location | 25 S Quaker Ln, Alexandria, Virginia |
| Authorized Official Name and Position | Benjamin Adewale (CEO) |
| Authorized Official Contact | 7035698028 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Mental And Medical Clinic 25 S Quaker Ln Suite 4 Alexandria VA 22314-4585 Ph: (571) 257-4398 | Riverside Mental And Medical Clinic 25 S Quaker Ln Suite 4 Alexandria VA 22314-4585 Ph: (571) 257-4398 |
| NPI Number | 1992073084 |
|---|---|
| Provider Enumeration Date | 12/05/2011 |
| Last Update Date | 07/30/2013 |
| Medicare PECOS PAC ID | 2961469176 |
|---|---|
| Medicare Enrollment ID | O20130805000799 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992073084 | NPI | - | NPPES |
| 031768500 | Medicaid | DC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MD22004 (District Of Columbia) | Primary |
| Provider Name | Benjamin A Adewale |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790702132 PECOS PAC ID: 0345229571 Enrollment ID: I20040805001643 |
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