Healthcare Provider Details

I. General information

NPI: 1043133671
Provider Name (Legal Business Name): NOVA BEHAVIORAL HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26190 OCALA CIR
SOUTH RIDING VA
20152-4807
US

IV. Provider business mailing address

26190 OCALA CIR
SOUTH RIDING VA
20152-4807
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 TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

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