Provider Demographics
NPI:1356049365
Name:SYMBIOSIS MENTAL HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:SYMBIOSIS MENTAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:TERESE
Authorized Official - Last Name:IANNAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:571-492-4351
Mailing Address - Street 1:3804 WILSON BLVD # 1138
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1920
Mailing Address - Country:US
Mailing Address - Phone:571-492-4351
Mailing Address - Fax:
Practice Address - Street 1:3950 CHAINBRIDGE RD
Practice Address - Street 2:STE 4
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:843-290-4389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty