Healthcare Provider Details

I. General information

NPI: 1114543253
Provider Name (Legal Business Name): MENTAL HEALTH CENTER OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 03/17/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 PLUM ST SW
VIENNA VA
22180-6328
US

IV. Provider business mailing address

602 PLUM ST SW
VIENNA VA
22180-6328
US

V. Phone/Fax

Practice location:
  • Phone: 703-310-8563
  • Fax: 703-223-4940
Mailing address:
  • Phone: 703-310-8563
  • Fax: 703-223-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. NEDA RAHIMI
Title or Position: CEO
Credential:
Phone: 703-310-8563