| Clementine Twin Lakes, Llc | |
|
13215 Twin Lakes Dr Clifton VA 20124-1215 | |
| (305) 663-1876 | |
| (914) 479-5490 |
| Full Name | Clementine Twin Lakes, Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 13215 Twin Lakes Dr, Clifton, Virginia |
| Authorized Official Name and Position | Mike Bagley (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3056631876 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clementine Twin Lakes, Llc 6100 Sw 76th St South Miami FL 33143-5002 Ph: (305) 663-1876 | Clementine Twin Lakes, Llc 13215 Twin Lakes Dr Clifton VA 20124-1215 Ph: (305) 663-1876 |
| NPI Number | 1801375118 |
|---|---|
| Provider Enumeration Date | 08/08/2018 |
| Last Update Date | 03/20/2020 |
| Certification Date | 03/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801375118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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Infinite Wellness, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 13410 Trey Ln, Clifton, VA 20124 Phone: 571-295-4464 | |
The Corvus Center For Mental Health Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11915 Lilita Lane, Clifton, VA 20124 Phone: 703-424-7647 Fax: 703-424-7647 | |
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