Healthcare Provider Details

I. General information

NPI: 1205697828
Provider Name (Legal Business Name): LIMBIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 WILSON BLVD STE PMB246
ARLINGTON VA
22209-2220
US

IV. Provider business mailing address

1550 WILSON BLVD STE PMB246
ARLINGTON VA
22209
US

V. Phone/Fax

Practice location:
  • Phone: 703-721-8147
  • Fax:
Mailing address:
  • Phone: 703-721-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. DUSUBA F CONTEH
Title or Position: AUTHORIZED OFFICIAL
Credential: RN
Phone: 703-721-8147