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General NPI Number Information
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NPI Number | 1447495619
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Entity Type | Organization
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Legal Business Name | MIMIR CONSULTING, INC.
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 1100 N GLEBE RD STE 1010
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City | ARLINGTON
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State | VA
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Zip | 22201-5786
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Country | US
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Telephone | 202-257-9333
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Fax | 757-321-6269
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Provider Business Mailing Address
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Address Line | PO BOX 65053
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City | VIRGINIA BEACH
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State | VA
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Zip | 23467-5053
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Country | US
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Telephone | 757-714-1838
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Fax | 757-321-6269
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES P POLK
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Credential | PSYD LCP
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Telephone | 833-223-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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