FAIRFAX MENTAL HEALTH & WELLNESS


Address: 3554 Chain Bridge Rd, Suite 103, Fairfax, VA 22030-2709
Phone: 7038967628

FAIRFAX MENTAL HEALTH & WELLNESS (NPI# 1699201749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1699201749
Entity Type Organization
Organization Name FAIRFAX MENTAL HEALTH & WELLNESS
Practice Address 3554 Chain Bridge Rd
Suite 103
Fairfax
VA 22030-2709
Practice Telephone 7038967628
Mailing Telephone 7038967628
Enumeration Date 2017-05-11
Last Update Date 2017-05-11
Authorized Official Name MR. JONATHAN A SHORE (COO)
Authorized Official Telephone 7036634041
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TC0700X Psychologist
Specialization: Clinical
810004513 VA Behavioral Health & Social Service Providers

Other Data Sources

Entity Type Entity Name Entity Address
Virginia Business Entities Fairfax Mental Health & Wellness Inc. 3554 Chain Bridge Rd Ste 200, Fairfax, Virginia 22030-2709

Office Location

Street Address 3554 CHAIN BRIDGE RD
SUITE 103
City FAIRFAX
State VA
Zip Code 22030-2709

Providers in the same location

NPI Name Taxonomy Address Enumeration
1811919038 Charlie Hae Hong Dentist 3554 Chain Bridge Rd, Suite 401, Fairfax, VA 22030-2709 2006-07-24
1124554969 Shelley L Williams Psychologist 3554 Chain Bridge Rd, Fairfax, VA 22030-2709 2017-05-11
1417225863 Jennifer Lynn Shore Psychologist 3554 Chain Bridge Rd, Suite 103, Fairfax, VA 22030-2709 2011-12-13
1093947558 Yu Kai Hsu Dentist 3554 Chain Bridge Rd, Suite 401, Fairfax, VA 22030 2009-08-18
1417133851 Dana W. Ericksen Dentist 3554 Chain Bridge Rd, Suite 401, Fairfax, VA 22030-2709 2008-01-16

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1558863027 Jacqueline Renee Bauer Skilled Nursing Facility 10701 Main Street, Fairfax, VA 22030 2018-03-01
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Taxonomy Information

Taxonomy Code 103TC0700X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Clinical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1699232173 Alexis Melville Psychologist 4094 Majestic Ln Unit 315, Fairfax, VA 22033-2104 2019-02-21
1558867333 Kyoung Deok Baik Psychologist 3554 Chain Bridge Rd Ste 103, Fairfax, VA 22030-2709 2018-04-02
1265849822 Shushan Campbell Psychologist 10521 Rosehaven St Ste 100, Fairfax, VA 22030-2877 2014-07-16
1679994867 Claire Bartick Psychologist 9707 Commonwealth Blvd, Fairfax, VA 22032-2824 2013-12-15
1972933364 Kim Havenner Psychologist 10805 Main St Ste 500, Fairfax, VA 22030-4747 2013-11-21
1912348343 Tanisha S Bracey Psychologist 5403 Cabot Ridge Ct, Fairfax, VA 22032-3214 2013-07-15
1477833168 Leslie Ann Hawkins Psychologist 9840 Main St Ste 201, Fairfax, VA 22031-3909 2011-08-25
1982998910 Barbara G Smith Psychologist 11216 Waples Mill Road, Suite 104, Fairfax, VA 22030 2011-06-07
1184918401 Martina Pavlicek Psychologist 11130 Fairfax Blvd Ste 305, Fairfax, VA 22030-5035 2011-06-03
1821303264 Lianna R Bennett Psychologist 3607 Chain Bridge Rd, Ste A, Fairfax, VA 22030-3242 2010-08-10
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Competitor

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City FAIRFAX
Zip Code 22030

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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