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General NPI Number Information
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NPI Number | 1316712854
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Entity Type | Organization
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Legal Business Name | PARADOX MENTAL HEALTH
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 12872 HARBOR DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2921
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Country | US
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Telephone | 571-946-5512
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Fax | 571-376-6506
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Provider Business Mailing Address
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Address Line | 6857 JOCKEY CLUB LN
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City | HAYMARKET
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State | VA
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Zip | 20169-2979
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Country | US
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Telephone | 703-932-9964
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE DAVILA
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Credential | PMHNP-BC
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Telephone | 703-932-9964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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