Provider Demographics
NPI:1407346695
Name:PIMMIT COUNSELING & WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:PIMMIT COUNSELING & WELLNESS CLINIC PLLC
Other - Org Name:PIMMIT COUNSELING & WELLNESS CLINIC ABA PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRZAD
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:POORSHAGHAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:703-556-4888
Mailing Address - Street 1:2235 CEDAR LN STE 102
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5247
Mailing Address - Country:US
Mailing Address - Phone:703-556-4888
Mailing Address - Fax:703-556-7774
Practice Address - Street 1:2235 CEDAR LN STE 102
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5247
Practice Address - Country:US
Practice Address - Phone:703-556-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5411165Medicaid