Healthcare Provider Details

I. General information

NPI: 1508519224
Provider Name (Legal Business Name): ADELYN HEAVIN LIM PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date: 08/15/2025
Reactivation Date: 11/14/2025

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: 703-776-4001
  • 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 Number0024196597
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001315563
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002101452
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: