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General NPI Number Information
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NPI Number | 1548835705
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Entity Type | Organization
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Legal Business Name | RENEWAL OF THE MIND
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 10560 MAIN ST
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City | FAIRFAX
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State | VA
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Zip | 22030-7182
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Country | US
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Telephone | 972-880-3510
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Fax |
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Provider Business Mailing Address
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Address Line | 13199 GUILDTOWN PL
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City | BRISTOW
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State | VA
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Zip | 20136-5613
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Country | US
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Telephone | 972-880-3510
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MRS. NAGLAA MOUSSA
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Credential | LPC
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Telephone | 972-880-3510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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