Organization
AMELVILLE HOLDINGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXIS MELVILLE (OWNER)
(860) 796-4553
Entity
Organization
Contact information
Practice address
4094 MAJESTIC LN UNIT 315, FAIRFAX, VA 22033-2104
(860) 796-4553
Mailing address
4094 MAJESTIC LN UNIT 315, FAIRFAX, VA 22033-2104
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
02/21/2019
Last updated
02/21/2019
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