CLEMENTINE TWIN LAKES, LLC is an adolescent and children mental health clinic center in Fairfax Station, VA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. CLEMENTINE TWIN LAKES, LLC NPI is 1689269250. The provider is registered as an organization entity type.
The provider's business location address is:
11329 HENDERSON RD
FAIRFAX STATION, VA
ZIP 22039-314
Phone: (305) 663-1876
The provider's authorized official is Mike Bagley .
The authorized official title is Chief Financial Officer and has the following contact phone number (305) 663-1876.
The CLIA number assigned to this NPI record is 49D2229962 - other - residential mental hlth with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 3/5/2021 and was last updated on 3/5/2021.