Provider Demographics
NPI:1326755497
Name:MENTAL HEALTH & ADDICTION SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:MENTAL HEALTH & ADDICTION SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALNORA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:703-953-8878
Mailing Address - Street 1:43330 JUNCTION PLZ STE 164-607
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3406
Mailing Address - Country:US
Mailing Address - Phone:703-953-8878
Mailing Address - Fax:
Practice Address - Street 1:43330 JUNCTION PLZ # 164-607
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3406
Practice Address - Country:US
Practice Address - Phone:703-953-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty