Healthcare Provider Details

I. General information

NPI: 1780141374
Provider Name (Legal Business Name): NEWWAVE BEHAVIORAL CONSULTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 HILLSMAN ST
FALLS CHURCH VA
22043-3336
US

IV. Provider business mailing address

2531 HILLSMAN ST
FALLS CHURCH VA
22043-3336
US

V. Phone/Fax

Practice location:
  • Phone: 520-907-1351
  • Fax:
Mailing address:
  • Phone: 520-907-1351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANDANA ROUSHANMEIDAN
Title or Position: BEHAVIOR ANALYST
Credential: BCBA
Phone: 520-907-1351