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10801 Henry Abbott Rd Bristow VA 20136-2804 | |
| (703) 622-6055 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 10801 Henry Abbott Rd, Bristow, Virginia |
| Authorized Official Name and Position | Shirrie Jones (LICENSE PROFESSIONAL COUNSELING) |
| Authorized Official Contact | 5716060575 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10801 Henry Abbott Rd Bristow VA 20136-2804 Ph: () - | 10801 Henry Abbott Rd Bristow VA 20136-2804 Ph: (703) 622-6055 |
| NPI Number | 1154938793 |
|---|---|
| Provider Enumeration Date | 09/28/2020 |
| Last Update Date | 04/21/2022 |
| Certification Date | 04/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154938793 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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