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General NPI Number Information
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NPI Number | 1902590870
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Entity Type | Individual
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Provider Name | JIMMY NGUYEN M.ED.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 3915 BLENHEIM BLVD STE 23A
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City | FAIRFAX
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State | VA
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Zip | 22030-2432
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Country | US
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Telephone | 202-570-4965
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Fax |
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Provider Business Mailing Address
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Address Line | 14070 BIG CREST LN APT 409
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5535
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704015878
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License Number State | VA
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