Provider Demographics
NPI:1891472080
Name:EAGER MIND SERVICES
Entity Type:Organization
Organization Name:EAGER MIND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-303-9044
Mailing Address - Street 1:107 S WEST ST STE 116
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2824
Mailing Address - Country:US
Mailing Address - Phone:571-303-9044
Mailing Address - Fax:
Practice Address - Street 1:950 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2393
Practice Address - Country:US
Practice Address - Phone:571-303-9044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health