Healthcare Provider Details

I. General information

NPI: 1285474163
Provider Name (Legal Business Name): MANTRA MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 CEDAR LN STE 100
TYSONS VA
22182-5251
US

IV. Provider business mailing address

2220 CEDAR LN STE 100
TYSONS VA
22182-5251
US

V. Phone/Fax

Practice location:
  • Phone: 571-368-6654
  • Fax: 571-368-6655
Mailing address:
  • Phone: 571-368-6654
  • Fax: 571-368-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SONAL JAGASIA
Title or Position: OWNER
Credential: MD
Phone: 571-368-6654