CLEMENTINE TWIN LAKES, LLC (NPI# 1801375118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801375118 |
| Entity Type | Organization |
| Organization Name | CLEMENTINE TWIN LAKES, LLC |
| Practice Address |
13215 Twin Lakes Dr Clifton VA 20124-1215 |
| Mailing Address |
6100 Sw 76th St South Miami FL 33143-5002 |
| Practice Telephone | 3056631876 |
| Practice Fax Number | 9144795490 |
| Mailing Telephone | 3056631876 |
| Mailing Fax Number | 9144795490 |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2020-03-20 |
| Authorized Official Name | MR. MIKE BAGLEY (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 3056631876 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| Street Address |
13215 TWIN LAKES DR |
| City | CLIFTON |
| State | VA |
| Zip Code | 20124-1215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205350527 | Mary Berkley | Physical Therapy Assistant | 6706 Rock Fall Ct, Clifton, VA 20124 | 2017-07-28 |
| 1083155485 | Joseph Nicholas Martinez | Specialist/Technologist | 6590 Rockland Drive, Clifton, VA 20124 | 2017-03-17 |
| 1386075943 | Rowena Olifernes | Occupational Therapist | 13405 Trey Lane, Clifton, VA 20124 | 2013-12-09 |
| 1023318318 | Harold R Kober | Pharmacist | 6103 Union Village Dr., Clifton, VA 20124 | 2010-11-02 |
| 1679105936 | Erica Cavaluzzi | Dental Hygienist | 13532 Mallard Watch Way, Clifton, VA 20124-0920 | 2020-02-05 |
| 1164970828 | Morgan Cripe | Specialist/Technologist | 5670 Lonesome Dove Ct, Clifton, VA 20124-0925 | 2016-09-12 |
| 1700497245 | Leena Khan | Student in an Organized Health Care Education/Training Program | 5330 Sandy Point Ln, Clifton, VA 20124-0942 | 2020-08-10 |
| 1639506066 | Footprints Behavior Services LLC | Behavioral Analyst | 5878 Orchard Hill Ct, Clifton, VA 20124-1064 | 2013-09-30 |
| 1295123461 | Kim Kuykendall | Physical Therapy Assistant | 13512 Little Brook Dr, Clifton, VA 20124-1083 | 2014-12-22 |
| 1891905253 | Edwin Ross Adair IIi | Optometrist | 5718 Union Mill Rd, Clifton, VA 20124-1088 | 2007-05-23 |
| Find all providers in zip 20124 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679849723 | Care for Children International, Inc. | Clinic/Center | 13310 Compton Rd, Clifton, VA 20124-1512 | 2012-03-22 |
| 1518434083 | Ms Integrated Psychotherapy and Counseling LLC | Clinic/Center | 1157 Main Ave, Clifton, NJ 07011-2243 | 2018-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194325191 | Second Chance, LLC | Clinic/Center | 315 Hospital Dr Ste 105, Martinsville, VA 24112-1927 | 2020-10-28 |
| 1407454515 | Always Blossom, LLC | Clinic/Center | 611 W Graham Rd, Richmond, VA 23222-4207 | 2020-10-12 |
| 1225645377 | Crescent Moon Counseling LLC | Clinic/Center | 8016 Burrundie Dr, Richmond, VA 23225-1972 | 2020-09-23 |
| 1811512007 | Schwarz Counseling and Coaching | Clinic/Center | 8109 Mechanicsville Turnpike, Suite 1c, Mechanicsville, VA 23111 | 2020-06-12 |
| 1174146708 | Nova Telemental Health | Clinic/Center | 14012 Willet Way, Gainesville, VA 20155-5915 | 2020-05-18 |
| 1659993731 | Sandstone Care Virginia, LLC | Clinic/Center | 11415 Isaac Newton Sq S, Reston, VA 20190-5005 | 2020-05-12 |
| 1306467147 | Shenandoah Creative Counseling for Children and Adolescents | Clinic/Center | 510 W Broad St Ste H, Waynesboro, VA 22980-4548 | 2020-05-04 |
| 1801449855 | Amazing Counseling LLC | Clinic/Center | 2428 Windy Pines Bnd, Virginia Beach, VA 23456-3954 | 2019-07-18 |
| 1366007460 | Absolute Mental Health Clinic LLC | Clinic/Center | 1303 Florida Ave, Woodbridge, VA 22191-3620 | 2019-05-03 |
| 1912468190 | Village Therapeutic Mentoring Services LLC | Clinic/Center | 1 W Cary St, Richmond, VA 23220-5609 | 2019-03-28 |
| Find all providers with the same taxonomy | ||||
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| 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.