Healthcare Provider Details

I. General information

NPI: 1598166498
Provider Name (Legal Business Name): VIENNA BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 LAFAYETTE CENTER DRIVE. SUITE 1760
CHANTILLY VA
20151-1267
US

IV. Provider business mailing address

4229 LAFAYETTE CENTER DRIVE SUITE 1760
CHANTILLY VA
20151-1267
US

V. Phone/Fax

Practice location:
  • Phone: 703-865-0003
  • Fax: 703-865-0034
Mailing address:
  • Phone: 703-865-0003
  • Fax: 703-865-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101251769
License Number StateVA

VIII. Authorized Official

Name: DR. MOHAMMAD A ANSARI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 703-865-0003