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General NPI Number Information
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NPI Number | 1619612686
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Entity Type | Organization
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Legal Business Name | MINDFUL HEALING GROUP LLC
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 1485 CHAIN BRIDGE RD STE 302
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City | MC LEAN
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State | VA
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Zip | 22101-4501
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Country | US
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Telephone | 703-987-6500
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Fax | 240-219-3138
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Provider Business Mailing Address
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Address Line | 8601 LARKHAVEN TER
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-3313
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Country | US
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Telephone | 571-435-3334
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Fax | 240-219-3138
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KELLY RANKIN
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Credential | LCSW
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Telephone | 703-987-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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