Provider Demographics
NPI:1477897445
Name:FAIRFAX PSYCHIATRY & BEHAVIORAL HEALTH CO.
Entity Type:Organization
Organization Name:FAIRFAX PSYCHIATRY & BEHAVIORAL HEALTH CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HINNARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-594-1755
Mailing Address - Street 1:12486 ROSE PATH CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-6238
Mailing Address - Country:US
Mailing Address - Phone:571-594-1755
Mailing Address - Fax:703-218-8417
Practice Address - Street 1:2915 HUNTER MILL RD
Practice Address - Street 2:SUITE 14
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1716
Practice Address - Country:US
Practice Address - Phone:571-594-1755
Practice Address - Fax:703-218-8417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012317242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty