Provider Demographics
NPI:1598445751
Name:MINNIEAR, CHIN-CHIN (MA)
Entity Type:Individual
Prefix:
First Name:CHIN-CHIN
Middle Name:
Last Name:MINNIEAR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 BULL RUN CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-6901
Mailing Address - Country:US
Mailing Address - Phone:312-933-9571
Mailing Address - Fax:
Practice Address - Street 1:1768 BUSINESS CENTER DR STE 360
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5358
Practice Address - Country:US
Practice Address - Phone:312-933-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty