Provider Demographics
NPI:1235745936
Name:MOUNT VERNON FAMILY THERAPY
Entity Type:Organization
Organization Name:MOUNT VERNON FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRETOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEWAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-765-1400
Mailing Address - Street 1:2560 HUNTINGTON AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1448
Mailing Address - Country:US
Mailing Address - Phone:703-768-6240
Mailing Address - Fax:
Practice Address - Street 1:2560 HUNTINGTON AVE STE 302
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-1448
Practice Address - Country:US
Practice Address - Phone:703-768-6240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIFER MCEWAN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty