Provider Demographics
NPI:1275053183
Name:IM JUST ME MOVEMENT
Entity Type:Organization
Organization Name:IM JUST ME MOVEMENT
Other - Org Name:IJMM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MENTOR, PRS
Authorized Official - Phone:703-344-6206
Mailing Address - Street 1:117 E PICCADILLY ST FL 3
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-5095
Mailing Address - Country:US
Mailing Address - Phone:703-344-6206
Mailing Address - Fax:
Practice Address - Street 1:117 E PICCADILLY ST FL 3
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-5095
Practice Address - Country:US
Practice Address - Phone:703-344-6206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 175T00000X, 252Y00000X, 253Z00000X
VA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275053183Medicaid