Healthcare Provider Details

I. General information

NPI: 1629997887
Provider Name (Legal Business Name): BEHAVIORAL MEDICINE OF VIRGINIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 TWIN HICKORY RD STE A
GLEN ALLEN VA
23059-5783
US

IV. Provider business mailing address

5310 TWIN HICKORY RD STE A
GLEN ALLEN VA
23059-5783
US

V. Phone/Fax

Practice location:
  • Phone: 703-891-4354
  • Fax: 703-891-4355
Mailing address:
  • Phone: 703-891-4354
  • Fax: 703-891-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: FARIHA BANGASH
Title or Position: MD
Credential:
Phone: 703-891-4354