Healthcare Provider Details

I. General information

NPI: 1942065768
Provider Name (Legal Business Name): MIND MEADOW COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 JERMANTOWN RD STE 440
FAIRFAX VA
22030-4900
US

IV. Provider business mailing address

3900 JERMANTOWN RD STE 440
FAIRFAX VA
22030-4900
US

V. Phone/Fax

Practice location:
  • Phone: 703-972-2120
  • Fax: 703-972-2891
Mailing address:
  • Phone: 703-972-2120
  • Fax: 703-972-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ZACKARY ALJURIDE
Title or Position: OPERATIONS
Credential:
Phone: 786-966-5466