Clementine Twin Lakes, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CLEMENTINE TWIN LAKES, LLC

Doing business as

Monte Nido Tysons Corner Day Treatment

Practice address

8180 Greensboro Dr Ste 375
MC Lean, VA 22102-3888

Phone

(571) 569-4929

Fax

(571) 762-0865

NPI assigned

Jan 19, 2024

Last updated

Jun 26, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Edward Moody

Title

Chief Financial Officer

Phone

(571) 334-3144

Specialties & licenses 1

Addresses

Other names 1

• Monte Nido Tysons Corner Day Treatment Doing business as

Tax ID family

Clementine Twin Lakes LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Clementine Twin Lakes, LLC

  dba Clementine Fairfax

  • Psychiatric Residential Treatment Facility
  • Fairfax Station, VA
  • NPI 1689269250
  NPD tax ID
• Clementine Twin Lakes, LLC

  • Psychiatric Residential Treatment Facility
  • Clifton, VA
  • NPI 1801375118
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1033970603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 SW 76TH ST",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331435002",
            "telephone_number": "305-663-1876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8180 GREENSBORO DR STE 375",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221023888",
            "telephone_number": "571-569-4929",
            "fax_number": "571-762-0865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMENTINE TWIN LAKES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "571-334-3144",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monte Nido Tysons Corner Day Treatment",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monte Nido Tysons Corner Day Treatment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kailin April Clanton, PA
• Claudette Pilger, Psy.D., Inc.
• Tanya Marie Clausen, LCSW
• Marleine Shafik Clay, MD
• Laura G. Clement, LCSW, LCSW-C, LICSW
• Melonye Neiley Cleveland
• Amanda Jill Cloninger, LMSW
• Kara Clough, LCSW
• Risa Joy Clow, RBT
• Chelsea Dawn Cluck

• Mental Health Clinic/Center (Including Community Mental Health Center) in McLean, VA
• Providers in McLean, VA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.