Convergence Mental Performance And Preparation Lab
LBN: Convergence Mental Performance And Preparation Lab
Convergence Mental Performance And Preparation Lab is an health care organization with primary practice located at 4000 Legato Rd Ste 1100 , Fairfax VA 22033-2893. The organization recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Exercise & Sports, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is the primary health care specialty.
Convergence Mental Performance And Preparation Lab can be contacted via phone (571) 336-2272, or through Butler, Tawana via phone (817) 913-5428.
Contact Information
Primary practice address
4000 Legato Rd Ste 1100
Fairfax VA 22033-2893
Phone: (571) 336-2272
Fax:
Website:
Authorized official contact:
Name: Butler, Tawana Licensed Clinical Social Worker (LCSW)
Phone: (817) 913-5428
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | ||
| Behavioral Health & Social Service Providers / Exercise & Sports | 103TE1100X | ||
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X |
Profile Details
| NPI number | 1346015815 |
|---|---|
| LBN Legal business name | Convergence Mental Performance And Preparation Lab |
| DBA Doing business as | |
| Authorized official | Butler, Tawana Licensed Clinical Social Worker (LCSW) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Nov 15th, 2023 |
| Last updated | Nov 15th, 2023 - about last year |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
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