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General NPI Number Information
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NPI Number | 1598166498
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Entity Type | Organization
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Legal Business Name | VIENNA BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 421 CHURCH ST NE SUITE B
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City | VIENNA
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State | VA
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Zip | 22180-4708
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Country | US
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Telephone | 703-865-0003
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Fax |
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Provider Business Mailing Address
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Address Line | 421 CHURCH ST NE SUITE B
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City | VIENNA
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State | VA
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Zip | 22180-4708
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Country | US
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Telephone | 703-865-0003
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. MOHAMMAD A ANSARI
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Credential | MD
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Telephone | 703-865-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101251769
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License Number State | VA
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