Organization
MENTAL HEALTH THERAPY CENTER - NORTHERN VIRGINIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE GINGRAS (DIVISION CFO)
(804) 228-4901
Entity
Organization
Contact information
Practice address
10721 MAIN ST STE 1300, FAIRFAX, VA 22030-6902
(703) 536-2000
Mailing address
10721 MAIN ST STE 1300, FAIRFAX, VA 22030-6902
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
06/04/2024
Last updated
06/04/2024
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