Organization
FAIRFAX MENTAL HEALTH & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON SHORE (CEO)
(732) 996-6164
Entity
Organization
Contact information
Practice address
3554 CHAIN BRIDGE RD STE 200, FAIRFAX, VA 22030-2709
(703) 896-7628
Mailing address
3554 CHAIN BRIDGE RD STE 200, FAIRFAX, VA 22030-2709
(703) 896-7628
(703) 890-2359
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
05/11/2017
Last updated
02/19/2025
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