Basic Information
| Provider Information | |||||||||
| NPI: | 1588977748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROPSYCH WELLNESS CENTER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 220403 | ||||||||
| Address2: | |||||||||
| City: | CHANTILLY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201530403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036261420 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3930 PENDER DR STE 350 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220300989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038658686 | ||||||||
| FaxNumber: | 7038656506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2010 | ||||||||
| LastUpdateDate: | 06/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | KUMAR | ||||||||
| AuthorizedOfficialFirstName: | ALOK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7036261420 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 0101246802 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.