Provider Demographics
NPI:1750120762
Name:MIND BODY CONNECTIONS LLC
Entity type:Organization
Organization Name:MIND BODY CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:703-705-9880
Mailing Address - Street 1:13380 HUDSON PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-1708
Mailing Address - Country:US
Mailing Address - Phone:703-705-9880
Mailing Address - Fax:
Practice Address - Street 1:13380 HUDSON PL
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-1708
Practice Address - Country:US
Practice Address - Phone:703-753-9496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty