MEDICARE: EAGER MIND SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1891472080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGER MIND SERVICES

Provider Business Mailing Address
First Line	:	107 S WEST ST STE 116
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2824
Country	:	US
Telephone Number	:	571-303-9044
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 N WASHINGTON ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2393
Country	:	US
Telephone Number	:	571-303-9044
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAQUEL LUSTER
Credential	:
Telephone Number	:	571-303-9044

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

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Directions to “EAGER MIND SERVICES ” Practice Location

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