Healthcare Provider Details

I. General information

NPI: 1497719272
Provider Name (Legal Business Name): T MED BEHAVIORAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610A SANDY LEWIS DR
FAIRFAX VA
22032-4034
US

IV. Provider business mailing address

5610A SANDY LEWIS DR
FAIRFAX VA
22032-4034
US

V. Phone/Fax

Practice location:
  • Phone: 703-425-8269
  • Fax: 703-425-6020
Mailing address:
  • Phone: 703-425-8269
  • Fax: 703-425-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ZEE L. FRIEDMAN
Title or Position: PRESIDENT
Credential:
Phone: 703-425-8269