Healthcare Provider Details

I. General information

NPI: 1851107544
Provider Name (Legal Business Name): RCH BRAIN & MIND CENTER VA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 420
FAIRFAX VA
22031-5216
US

IV. Provider business mailing address

1307 8TH AVE STE 403
FORT WORTH TX
76104-4143
US

V. Phone/Fax

Practice location:
  • Phone: 571-307-2741
  • Fax:
Mailing address:
  • Phone: 682-394-3500
  • Fax: 817-862-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE WILLIAMS
Title or Position: FINANCIAL ANAYLST
Credential:
Phone: 817-629-0752