Eden Total Care
Nurse Practitioner, Psych/Mental Health in Vienna, VA. Organization (NPI-2).
NPI number1073345708
StatusActive
Last updated in NPPESAug 20, 2024
Details
- NPI
- 1073345708
- Entity type
- Organization (NPI-2)
- Legal business name
- Eden Total Care
- Organization subpart
- No
- Enumeration date
- Aug 20, 2024
- Certification date
- Aug 20, 2024
- Last updated
- Aug 20, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | Yes |
Practice location
8300 Boone Blvd Ste 500Vienna, VA 22182-2681
Phone 832-833-4125
Mailing address
6250 Jasper DrRembert, SC 29128-9133
Phone 803-565-9758
Authorized official
Deneice Wickens
Owner/Provider
8328334125
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