Healthcare Provider Details

I. General information

NPI: 1487128138
Provider Name (Legal Business Name): ALEX MAURICIO MEJIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15941 DONALD CURTIS DR STE 200
WOODBRIDGE VA
22191-4257
US

IV. Provider business mailing address

8300 CANNISTER CT
FREDERICKSBURG VA
22407-1907
US

V. Phone/Fax

Practice location:
  • Phone: 703-792-4900
  • Fax: 703-792-5699
Mailing address:
  • Phone: 703-221-3348
  • Fax: 703-221-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010729
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: