Provider Demographics
NPI:1740386762
Name:PIMMIT COUNSELING & WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:PIMMIT COUNSELING & WELLNESS CLINIC PLLC
Other - Org Name:PIMMIT COUNSELING & WELLNESS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAHRZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:POORSHAGHAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LPC, NCC
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:703-556-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002934101YP2500X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005411165Medicaid