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General NPI Number Information
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NPI Number | 1336764737
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Entity Type | Organization
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Legal Business Name | THE CORVUS CENTER FOR MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 11915 LILITA LANE
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City | CLIFTON
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State | VA
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Zip | 20124
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Country | US
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Telephone | 703-424-7647
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Fax | 703-424-7647
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Provider Business Mailing Address
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Address Line | PO BOX 244
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City | CLIFTON
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State | VA
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Zip | 20124-0244
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Country | US
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Telephone | 973-727-2745
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH MULHAUL
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Credential | LCSW
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Telephone | 973-727-2745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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