Organization
AVESTA ALTERNATIVE CARE
Active
Organization
AVESTA ALTERNATIVE CARE
Active
Other names
Avesta Ketamine and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LADAN ESHKEVARI PHD, CRNA (OWNER)
(703) 201-7767
Entity
Organization
Contact information
Practice address
6861 ELM ST STE 3E, MC LEAN, VA 22101-6036
(703) 646-6343
Mailing address
1268 BEVERLY RD, MC LEAN, VA 22101-2834
(703) 201-7767
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033703061
NPI
—
01
—
1073153805
NPI
—
Enumeration date
04/13/2022
Last updated
04/13/2022
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