Organization
PROVIDENCE BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAH EZE (OWNER)
(703) 950-9202
Entity
Organization
Contact information
Practice address
15262 FLINTLOCK TER, WOODBRIDGE, VA 22191
(703) 950-9202
Mailing address
4222 FORTUNA CENTER PLZ STE 607, DUMFRIES, VA 22025-1515
(703) 650-9202
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/28/2023
Last updated
10/26/2023
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