Healthcare Provider Details

I. General information

NPI: 1356442206
Provider Name (Legal Business Name): VIRGINIA MENTAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MICHAEL FARADAY DR STE 206
RESTON VA
20190-5312
US

IV. Provider business mailing address

11123 COROBON LN
GREAT FALLS VA
22066-1403
US

V. Phone/Fax

Practice location:
  • Phone: 888-237-5426
  • Fax: 703-763-2350
Mailing address:
  • Phone: 304-279-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101235819
License Number StateVA

VIII. Authorized Official

Name: SHAHNOOR ALI KHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 703-400-3433