Organization
COMMONWEALTH OF VIRGINIA DEPT OF MENTAL HEALTH AND NORTHERN VIRGINIA T
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAQUWANDA BAKER (OFFICE MANAGER)
(703) 323-4093
Entity
Organization
Contact information
Practice address
9901 BRADDOCK RD, FAIRFAX, VA 22032-1904
(703) 323-4093
Mailing address
9901 BRADDOCK RD, FAIRFAX, VA 22032-1904
(703) 323-4093
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
0101233274
VA
208000000X
Pediatrics Physician
0101040712
VA
2084N0400X
Neurology Physician
0101046923
VA
2084P0005X
Neurodevelopmental Disabilities Physician
0101034545
VA
Other
Enumeration date
12/20/2007
Last updated
06/19/2008
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