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General NPI Number Information
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NPI Number | 1326618778
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Entity Type | Organization
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Legal Business Name | WASHINGTON MINDCARE INSTITUTE
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 10560 MAIN ST STE 508
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City | FAIRFAX
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State | VA
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Zip | 22030-7173
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Country | US
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Telephone | 571-277-9515
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Fax |
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Provider Business Mailing Address
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Address Line | 10560 MAIN ST STE 508
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City | FAIRFAX
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State | VA
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Zip | 22030-7173
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Country | US
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Telephone | 571-277-9515
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. EUNHEE SONG
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Credential |
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Telephone | 703-277-9515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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