Healthcare Provider Details

I. General information

NPI: 1730989310
Provider Name (Legal Business Name): NEW BEGINNINGS INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22365 BRODERICK DR STE 330
STERLING VA
20166-9603
US

IV. Provider business mailing address

9230 OLD KEENE MILL RD # 1036
BURKE VA
22015-4201
US

V. Phone/Fax

Practice location:
  • Phone: 555-555-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ANDREA KASSIM
Title or Position: CEO
Credential:
Phone: 703-651-2634