# MIND BRIDGE CENTER LLC

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

## Provider details

- **NPI number:** 1790304616
- **Authorized official:** DR. KURWA NYIGU MD (CEO)
- **Authorized official phone:** (336) 624-7164

## Contact information

- **Practice address:** 1390 CHAIN BRIDGE RD \# 10033, MC LEAN, VA 22101-3904
- **Practice address phone:** (571) 766-8107
- **Mailing address:** 1390 CHAIN BRIDGE RD \# 10033, MC LEAN, VA 22101-3904
- **Mailing address phone:** (571) 766-8107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/10/2020
- **Last updated:** 04/10/2020