Healthcare Provider Details

I. General information

NPI: 1073437570
Provider Name (Legal Business Name): VERIDIAN MINDCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8171 GLADE BANK DR
MANASSAS VA
20111-5239
US

IV. Provider business mailing address

8171 GLADE BANK DR
MANASSAS VA
20111-5239
US

V. Phone/Fax

Practice location:
  • Phone: 202-597-9483
  • Fax:
Mailing address:
  • Phone: 202-597-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMINA YASMIN
Title or Position: OWNER
Credential:
Phone: 202-597-9483