Fairfax Mental Health & Wellness
Psychologist, Clinical in Fairfax, VA. Organization (NPI-2).
NPI number1699201749
StatusActive
Last updated in NPPESFeb 19, 2025
Details
- NPI
- 1699201749
- Entity type
- Organization (NPI-2)
- Legal business name
- Fairfax Mental Health & Wellness
- Organization subpart
- No
- Enumeration date
- May 11, 2017
- Certification date
- Feb 19, 2025
- Last updated
- Feb 19, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | – | – | Yes |
| 101YP2500X | Counselor, Professional | – | – | |
| 1041C0700X | Social Worker, Clinical | – | – | |
| 2084P0800X | Psychiatry & Neurology, Psychiatry | – | – |
Practice location
3554 Chain Bridge Rd Ste 200Fairfax, VA 22030-2709
Phone 703-896-7628
Mailing address
3554 Chain Bridge Rd Ste 200Fairfax, VA 22030-2709
Phone 703-896-7628 · Fax 703-890-2359
Authorized official
Jon Shore
Ceo
7329966164
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