Healthcare Provider Details

I. General information

NPI: 1134918683
Provider Name (Legal Business Name): UNITY KIDS BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21525 RIDGETOP CIR STE 110
DULLES VA
20166-6510
US

IV. Provider business mailing address

21525 RIDGETOP CIR STE 110
DULLES VA
20166-6510
US

V. Phone/Fax

Practice location:
  • Phone: 703-926-9122
  • Fax:
Mailing address:
  • Phone: 703-926-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LANA MAHGOUB
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PHD, LCP
Phone: 703-926-9122