Healthcare Provider Details

I. General information

NPI: 1164370748
Provider Name (Legal Business Name): SHARED SMILE BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

12020 SUNRISE VALLEY DR STE 100
RESTON VA
20191-3429
US

V. Phone/Fax

Practice location:
  • Phone: 703-755-0953
  • Fax:
Mailing address:
  • Phone: 703-755-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADELYN LIM
Title or Position: NURSE PRACTITIONER
Credential: DNP, PMHNP
Phone: 303-718-6245