Healthcare Provider Details

I. General information

NPI: 1154356244
Provider Name (Legal Business Name): FAIRFAX COUNTY, VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12011 GOVERNMENT CENTER PARKWAY SUITE 836
FAIRFAX VA
22035
US

IV. Provider business mailing address

12011 GOVERNMENT CENTER PKWY STE 836
FAIRFAX VA
22035-1100
US

V. Phone/Fax

Practice location:
  • Phone: 703-324-7000
  • Fax: 703-653-6626
Mailing address:
  • Phone: 703-324-7000
  • Fax: 703-653-6626

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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number113
License Number StateVA

VIII. Authorized Official

Name: BARBARA WADLEY-YOUNG
Title or Position: ACTING EXECUTIVE DIRECTOR
Credential:
Phone: 703-324-4431