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General NPI Number Information
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NPI Number | 1295852622
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Entity Type | Organization
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Legal Business Name | GEORGE MASON UNIVERSITY CENTER FOR PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 10340 DEMOCRACY LN SUITE 202
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City | FAIRFAX
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State | VA
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Zip | 22030-2518
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Country | US
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Telephone | 703-993-1370
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Fax | 703-993-0035
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Provider Business Mailing Address
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Address Line | 4400 UNIVERSITY DRIVE GEORGE MASON UNIVERSITY, MS2C6
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City | FAIRFAX
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State | VA
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Zip | 22030
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Country | US
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Telephone | 703-993-1370
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Fax | 703-352-0035
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROBYN S MEHLENBECK
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Credential | PH.D.
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Telephone | 703-993-1371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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