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General NPI Number Information
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NPI Number | 1003623067
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Entity Type | Organization
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Legal Business Name | NJB BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 2800 EISENHOWER AVE STE 220
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4587
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Country | US
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Telephone | 703-598-4115
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Fax |
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Provider Business Mailing Address
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Address Line | 17600 BARRON HEIGHTS RD
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City | DUMFRIES
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State | VA
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Zip | 22025-2054
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZE OFFICIAL
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Name | GEORGINA COCA
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Credential | PMHNP
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Telephone | 703-598-4115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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