MEDICARE: MIND CHRONICLES THERAPEUTIC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1568116333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND CHRONICLES THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	950 N WASHINGTON ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2393
Country	:	US
Telephone Number	:	973-830-7176
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 N WASHINGTON ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2393
Country	:	US
Telephone Number	:	973-830-7176
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CLINICAL DIRECTOR
Name	:	NAJAH Z DAIL
Credential	:	LPC
Telephone Number	:	973-830-7301

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/09/2022

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