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General NPI Number Information
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NPI Number | 1962103549
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Entity Type | Organization
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Legal Business Name | FAMILY MENTAL HEALTH OF VIRGINIA, LLC
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 4001 PRINCE WILLIAM PKWY STE 301
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City | WOODBRIDGE
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State | VA
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Zip | 22192-7667
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Country | US
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Telephone | 202-390-4243
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Fax |
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Provider Business Mailing Address
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Address Line | 421 E COLUMBIA ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3502
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Country | US
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Telephone | 202-390-4243
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JONATHAN COLLEGIO
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Credential |
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Telephone | 202-390-4243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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