# SOLACE GROVE PSYCHIATRY PLLC

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

## Provider details

- **NPI number:** 1851249486
- **Authorized official:** SYDONIE BONGAM DNP, PMHNP-BC, FNP-C (PROVIDER (RENDERING PROVIDER))
- **Authorized official phone:** (240) 554-7071

## Contact information

- **Practice address:** 11350 RANDOM HILLS RD STE 856, FAIRFAX, VA 22030-6044
- **Practice address phone:** (240) 554-7071
- **Mailing address:** 11350 RANDOM HILLS RD STE 856, FAIRFAX, VA 22030-6044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/19/2026
- **Last updated:** 03/19/2026