Healthcare Provider Details

I. General information

NPI: 1366794745
Provider Name (Legal Business Name): BEHAVIORAL & PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 1/2 N WASHINGTON ST
ALEXANDRIA VA
22314-2311
US

IV. Provider business mailing address

411 1/2 N WASHINGTON ST
ALEXANDRIA VA
22314-2311
US

V. Phone/Fax

Practice location:
  • Phone: 703-825-8030
  • Fax:
Mailing address:
  • Phone: 703-825-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number4301071505
License Number StateMI

VIII. Authorized Official

Name: ABDUL ALEEM KHAN
Title or Position: PARTNER
Credential: M.D
Phone: 703-825-8030