Healthcare Provider Details

I. General information

NPI: 1306281928
Provider Name (Legal Business Name): BEHAVIORAL AND PSYCHIATRIC SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DUKE ST
ALEXANDRIA VA
22314-3512
US

IV. Provider business mailing address

1000 DUKE ST
ALEXANDRIA VA
22314-3512
US

V. Phone/Fax

Practice location:
  • Phone: 703-825-8030
  • Fax: 703-825-8003
Mailing address:
  • Phone: 703-825-8030
  • Fax: 703-825-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101234575
License Number StateVA

VIII. Authorized Official

Name: FAROOQ MOHYUDDIN
Title or Position: DIRECTOR
Credential:
Phone: 703-825-8030