Paradox Mental Health

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

PARADOX MENTAL HEALTH

Practice address

12872 Harbor Dr
Woodbridge, VA 22192-2921

Phone

(571) 946-5512

Fax

(571) 376-6506

NPI assigned

Nov 15, 2023

Last updated

Jul 9, 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

Stephanie Davila, PMHNP-BCNPI 1225762461

Title

Owner

Phone

(703) 932-9964

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephanie Barrett Davila, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Woodbridge, VA
  • NPI 1225762461
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1316712854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6857 JOCKEY CLUB LN",
            "city": "HAYMARKET",
            "state": "VA",
            "postal_code": "201692979",
            "telephone_number": "703-932-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12872 HARBOR DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922921",
            "telephone_number": "571-946-5512",
            "fax_number": "571-376-6506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADOX MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-15",
        "last_updated": "2024-07-09",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "DAVILA",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-932-9964",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.