Organization
CLEMENTINE TWIN LAKES, LLC
Active
Other names
Monte Nido Tysons Corner Day Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD MOODY (CHIEF FINANCIAL OFFICER)
(571) 334-3144
Entity
Organization
Contact information
Practice address
8180 GREENSBORO DR STE 375, MC LEAN, VA 22102-3888
(571) 569-4929
(571) 762-0865
Mailing address
6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
(305) 663-1876
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/19/2024
Last updated
06/26/2024
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