Provider Demographics
NPI:1356442206
Name:VIRGINIA MENTAL HEALTH INC
Entity Type:Organization
Organization Name:VIRGINIA MENTAL HEALTH INC
Other - Org Name:FAIRFAX PSYCHIATRY PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHNOOR
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-400-3433
Mailing Address - Street 1:11123 COROBON LN
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-1403
Mailing Address - Country:US
Mailing Address - Phone:304-279-9772
Mailing Address - Fax:
Practice Address - Street 1:1800 MICHAEL FARADAY DR STE 206
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5312
Practice Address - Country:US
Practice Address - Phone:888-237-5426
Practice Address - Fax:703-763-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012358192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101235819OtherSTATE MEDICAL LICENSE