Provider Demographics
NPI:1275646549
Name:NORTHERN VIRGINIA MENTAL HEALTH INSTITUTE
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA MENTAL HEALTH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIM DIRECTOR/PRIVACY/FOIA OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RHIT
Authorized Official - Phone:703-207-7158
Mailing Address - Street 1:3302 GALLOWS ROAD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3398
Mailing Address - Country:US
Mailing Address - Phone:703-207-7158
Mailing Address - Fax:703-207-7139
Practice Address - Street 1:3302 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3353
Practice Address - Country:US
Practice Address - Phone:703-207-7158
Practice Address - Fax:703-207-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208M00000X
VAVA STATE FACILITY283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-4010-5Medicaid
VA692748Medicare PIN
VA49-4010-5Medicaid
VA49-4010Medicare ID - Type Unspecified