Organization Active NPI

Pimmit Counseling & Wellness Clinic PLLC

  • Professional Counselor
  • Vienna, VA
National Provider Identifier
1740386762
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701002934 Issued in VA
Legal business name
PIMMIT COUNSELING & WELLNESS CLINIC PLLC
Practice address
2235 Cedar LN Ste 102
Vienna, VA 22182-5247
Phone
(703) 556-4888
Fax
(703) 556-7774
NPI assigned
Sep 16, 2006
Last updated
Oct 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Authorized official

Name
Mrs. Shahrzad Poorshaghaghi, ED.D, LPC, NCCNPI 1437171337
Title
Owner
Phone
(703) 556-4888

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
Professional Counselor 101YP2500X 0701002934 VA Primary
Behavior Analyst 103K00000X

Addresses

Primary practice location

2235 Cedar LN Ste 102
Vienna, VA 22182-5247

Mailing address

2235 Cedar LN Ste 102
Vienna, VA 22182-5247
Phone (703) 556-4888

Other identifiers 1

IdentifierTypeStateIssuer
005411165MedicaidVA

Other names 1

  • Pimmit Counseling & Wellness Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240909003702 DC Part B Supplier - Clinic/Group Practice 0941363956 Receives reassigned benefits from 1 practitioner
Practice locations: Vienna, VA

National Provider Directory

National Provider Directory

Locations

2235 Cedar Ln
Ste 102
Vienna, VA 22182
Phone (703) 350-8760

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1740386762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2235 CEDAR LN STE 102",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221825247",
            "telephone_number": "703-556-4888",
            "fax_number": "703-556-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 CEDAR LN STE 102",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221825247",
            "telephone_number": "703-556-4888",
            "fax_number": "703-556-7774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIMMIT COUNSELING & WELLNESS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "POORSHAGHAGHI",
        "authorized_official_first_name": "SHAHRZAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-556-4888",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ED.D, LPC, NCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701002934",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005411165",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pimmit Counseling & Wellness Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Vienna, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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.