# VITIRA MENTAL HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265131148
- **Authorized official:** MARIAH EZE (OWNER)
- **Authorized official phone:** (703) 950-9202

## Contact information

- **Practice address:** 12751 MARBLESTONE DR STE 240, WOODBRIDGE, VA 22192-8336
- **Practice address phone:** (703) 950-9202
- **Practice address fax:** (703) 650-9414
- **Mailing address:** 12751 MARBLESTONE DR STE 240, WOODBRIDGE, VA 22192-8336
- **Mailing address phone:** (703) 650-9202
- **Mailing address fax:** (703) 650-9414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/28/2023
- **Last updated:** 09/23/2026