| Ephesians Life Ministries | |
|
260 Cedar Ln Se # B Vienna VA 22180-6698 | |
| (703) 204-0250 | |
| Not Available |
| Full Name | Ephesians Life Ministries |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 260 Cedar Ln Se # B, Vienna, Virginia |
| Authorized Official Name and Position | Sunny S Park (THERAPIST) |
| Authorized Official Contact | 2404723216 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ephesians Life Ministries 1620 Elton Rd Ste 204 Silver Spring MD 20903-1760 Ph: (301) 439-7191 | Ephesians Life Ministries 260 Cedar Ln Se # B Vienna VA 22180-6698 Ph: (703) 204-0250 |
| NPI Number | 1003967563 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003967563 | NPI | - | NPPES |
| 7839381 | Other | MD | AETNA |
| 258321 | Other | MD | KAISER |
| 2133171 | Other | MD | MAMSI |
| 351252 | Other | MD | MHN |
| 633647 | Other | MD | NCPPO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 11220 (Maryland) | Secondary |
| 101YM0800X | Counselor - Mental Health | 0904005471 (Virginia) | Primary |
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