Organization
NINAS HEALTH CARE FAIRFAX INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE FONGOD (PRESIDENT)
(614) 314-5416
Entity
Organization
Contact information
Practice address
3022 JAVIER RD STE 105E, FAIRFAX, VA 22031-4646
(614) 314-5416
Mailing address
3022 JAVIER RD STE 105E, FAIRFAX, VA 22031-4646
(614) 314-5416
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/05/2019
Last updated
11/04/2025
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