Organization
COMMONWEALTH OF VIRGINIA DEPT OF MENTAL HEALTH AND NORTHERN VIRGINIA T
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK S DIORIO PH.D., MPH (FACILITY DIRECTOR)
(703) 323-4002
Entity
Organization
Contact information
Practice address
9901 BRADDOCK RD, FAIRFAX, VA 22032-1904
(703) 323-4000
(703) 323-4252
Mailing address
9901 BRADDOCK RD, FAIRFAX, VA 22032-1904
(703) 323-4000
(703) 323-4252
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49-6630-9
—
VA
Enumeration date
06/25/2006
Last updated
06/19/2008
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