Healthcare Provider Details

I. General information

NPI: 1760723670
Provider Name (Legal Business Name): MR. BASSEL FOUAD HELMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 PLANK RD STE 100 ELITE ACADEMY
FREDERICKSBURG VA
22407-0138
US

IV. Provider business mailing address

4510 PLANK ROAD, STE. 100, BOX 5 ELITE ACADEMY
FREDERICKSBURG VA
22407-0138
US

V. Phone/Fax

Practice location:
  • Phone: 540-412-5028
  • Fax: 540-412-5030
Mailing address:
  • Phone: 540-412-5028
  • Fax: 540-412-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: