Restore Mental Health Services LLC

Primary specialty

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

Legal business name

RESTORE MENTAL HEALTH SERVICES LLC

Practice address

4000 Legato Rd Ste 1100
Fairfax, VA 22033-2893

Phone

(571) 358-8692

NPI assigned

Oct 19, 2022

Organization subpart

No

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

Authorized official

Name

Uchechi Anyalebechi

Title

Nurse Practitioner

Phone

(571) 358-8692

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666137600000",
    "number": "1871219972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 LEGATO RD STE 1100",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 LEGATO RD STE 1100",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332893",
            "telephone_number": "571-358-8692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE MENTAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-19",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A",
        "authorized_official_last_name": "ANYALEBECHI",
        "authorized_official_first_name": "UCHECHI",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "571-358-8692"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15013327",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Fairfax, VA
• Providers in Fairfax, 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 Oct 19, 2022; 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.