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General NPI Number Information
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NPI Number | 1154356244
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Entity Type | Organization
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Legal Business Name | FAIRFAX COUNTY, VIRGINIA
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 12011 GOVERNMENT CENTER PARKWAY SUITE 836
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City | FAIRFAX
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State | VA
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Zip | 22035
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Country | US
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Telephone | 703-324-7000
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Fax | 703-653-6626
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Provider Business Mailing Address
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Address Line | 12011 GOVERNMENT CENTER PARKWAY SUITE 836
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City | FAIRFAX
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State | VA
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Zip | 22035
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Country | US
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Telephone | 703-324-7000
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Fax | 703-653-6626
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DARYL WASHINGTON
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Credential |
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Telephone | 703-324-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 113
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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