Healthcare Provider Details

I. General information

NPI: 1043171523
Provider Name (Legal Business Name): VALLEY PRIMARY & BEHAVIORAL HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 MCCORMICK FARM DR
MANASSAS VA
20110-6934
US

IV. Provider business mailing address

10625 MCCORMICK FARM DR
MANASSAS VA
20110-6934
US

V. Phone/Fax

Practice location:
  • Phone: 571-306-8614
  • Fax: 202-519-8044
Mailing address:
  • Phone: 571-306-8614
  • Fax: 202-519-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THERESA JUANA-KAMANDA
Title or Position: OWNER
Credential: NP
Phone: 571-306-8614