Healthcare Provider Details

I. General information

NPI: 1740109354
Provider Name (Legal Business Name): AKA VISION BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 COPPERMINE RD OFC NO119
HERNDON VA
20171-6163
US

IV. Provider business mailing address

13800 COPPERMINE RD OFC NO119
HERNDON VA
20171-6163
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-3498
  • Fax:
Mailing address:
  • Phone: 240-413-3498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JUDE AKA ATEMAFAC
Title or Position: CEO / PROGRAM DIRECTOR
Credential:
Phone: 240-413-3498