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General NPI Number Information
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NPI Number | 1851174510
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Entity Type | Organization
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Legal Business Name | GEORGE MASON UNIVERSITY
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 4455 GEORGE MASON BLVD. THOMPSON HALL L040
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City | FAIRFAX
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State | VA
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Zip | 22030
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Country | US
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Telephone | 703-993-3938
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 UNIVERSITY DR # MS 4B6
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City | FAIRFAX
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State | VA
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Zip | 22030-4422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | NICOLE BEADLES
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Credential |
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Telephone | 703-993-5127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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