Organization
MINDSHAPE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY SPIVACK M.D. (OWNER)
(703) 841-1290
Entity
Organization
Contact information
Practice address
2960 SLEEPY HOLLOW RD, FALLS CHURCH, VA 22044-2030
(703) 536-2000
Mailing address
2501 N GLEBE RD, SUITE 303, ARLINGTON, VA 22207-3558
(703) 841-1290
(703) 841-1315
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
08/16/2016
Last updated
08/16/2016
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