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General NPI Number Information
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NPI Number | 1326651936
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Entity Type | Organization
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Legal Business Name | WISE MIND SOLUTIONS, LLC
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 2850 EISENHOWER AVE STE 105
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4567
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Country | US
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Telephone | 703-919-2021
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Fax |
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Provider Business Mailing Address
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Address Line | 2850 EISENHOWER AVE STE 105
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4567
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Country | US
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Telephone | 844-947-3326
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | DR. AMY FORTNEY PARKS
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Credential | LPC
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Telephone | 703-919-2021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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