Healthcare Provider Details

I. General information

NPI: 1922160597
Provider Name (Legal Business Name): ALEXANDRIA MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N SAINT ASAPH ST
ALEXANDRIA VA
22314-1941
US

IV. Provider business mailing address

720 N SAINT ASAPH ST
ALEXANDRIA VA
22314-1912
US

V. Phone/Fax

Practice location:
  • Phone: 703-838-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0904002208
License Number StateVA

VIII. Authorized Official

Name: SYLVAN DALLAS
Title or Position: ADMINISTRATIVE TECH
Credential:
Phone: 703-838-6400