Healthcare Provider Details

I. General information

NPI: 1154281145
Provider Name (Legal Business Name): NOVACARE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 BOONE BLVD STE 350
VIENNA VA
22182-2632
US

IV. Provider business mailing address

8230 BOONE BLVD STE 350
VIENNA VA
22182-2632
US

V. Phone/Fax

Practice location:
  • Phone: 571-224-7058
  • Fax:
Mailing address:
  • Phone: 571-224-7058
  • 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: YUSUF AZIM
Title or Position: OWNER
Credential: MD
Phone: 571-224-7058