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General NPI Number Information
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NPI Number | 1992689996
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Entity Type | Organization
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Legal Business Name | INTEGRATED MENTAL HEALTH CLINIC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 950 N WASHINGTON ST FL 3
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2398
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Country | US
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Telephone | 703-570-5657
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Fax | 703-570-5661
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Provider Business Mailing Address
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Address Line | 4014 DIAMONDHEAD AVE
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City | BOWIE
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State | MD
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Zip | 20721-1308
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Country | US
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Telephone | 202-352-1553
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HENRY JIMENEZ
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Credential |
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Telephone | 202-352-1553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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