Organization
PRINCE WILLIAM COUNTY COMMUNITY SERVICES BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANSAR SHAND (MANAGER)
(703) 792-7800
Entity
Organization
Contact information
Practice address
7969 ASHTON AVE, MANASSAS, VA 20109-2885
(703) 792-7800
(703) 792-5699
Mailing address
7969 ASHTON AVE, MANASSAS, VA 20109-2885
(703) 792-7800
(703) 792-5699
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945247
—
VA
05
—
004978277
—
VA
01
—
210245
BLUE CROSS BLUE SHIELD
VA
Enumeration date
09/27/2006
Last updated
10/30/2013
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