NPIMap

Organization Active NPI

Holistic Psychiatry and Medical Center LLC

  • Multi-Specialty Clinic/Center
  • Stafford, VA
National Provider Identifier
1184393159
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
HOLISTIC PSYCHIATRY AND MEDICAL CENTER LLC
Practice address
556 Garrisonville Rd Ste 210
Stafford, VA 22554-7819
Phone
(301) 917-5808
Fax
(571) 774-4123
NPI assigned
Sep 12, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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

Authorized official

Name
Doris Cudjoe Owusu, PMHNP, FNPNPI 1780287607
Title
Owner
Phone
(571) 315-3313

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

556 Garrisonville Rd Ste 210
Stafford, VA 22554-7819

Mailing address

214 Determination Dr
Stafford, VA 22554-3366
Phone (301) 917-5808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211124000197 VA Part B Supplier - Clinic/Group Practice 9931599461 Receives reassigned benefits from 4 practitioners
Practice locations: Stafford, VA

National Provider Directory

National Provider Directory

Locations

556 Garrisonville Rd
Ste 210
Stafford, VA 22554
Phone (301) 917-5808

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1631404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701734400000",
    "number": "1184393159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 DETERMINATION DR",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225543366",
            "telephone_number": "301-917-5808",
            "fax_number": "571-774-4123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "556 GARRISONVILLE RD STE 210",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225547819",
            "telephone_number": "301-917-5808",
            "fax_number": "571-774-4123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLISTIC PSYCHIATRY AND MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-12",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A",
        "authorized_official_last_name": "OWUSU",
        "authorized_official_first_name": "DORIS",
        "authorized_official_middle_name": "CUDJOE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "571-315-3313",
        "authorized_official_credential": "PMHNP, FNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stafford, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.