NPIMap

Organization Active NPI

Family Mental Health of Virginia, LLC

Doing business as Ellie Mental Health

  • Clinical Social Worker
  • Woodbridge, VA
National Provider Identifier
1962103549
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
FAMILY MENTAL HEALTH OF VIRGINIA, LLC
Doing business as
Ellie Mental Health
Practice address
4001 Prince William Pkwy Ste 301
Woodbridge, VA 22192-7667
Phone
(202) 390-4243
NPI assigned
Mar 13, 2023
Last updated
Jun 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Authorized official

Name
Mr. Jonathan Collegio
Title
Owner
Phone
(202) 390-4243

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

4001 Prince William Pkwy Ste 301
Woodbridge, VA 22192-7667

Mailing address

421 E Columbia St
Falls Church, VA 22046-3502
Phone (202) 390-4243

Other names 1

  • Ellie Mental Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230707002998 VA Part B Supplier - Clinic/Group Practice 5395104319 Receives reassigned benefits from 6 practitioners
Practice locations: Manassas, VA; Woodbridge, VA

National Provider Directory

National Provider Directory

Locations

9400 Innovation Dr
Ste 104
Manassas, VA 20110
Phone (571) 506-7861

4001 Prince William Pkwy
Ste 301
Woodbridge, VA 22192
Phone (703) 670-2895

Practitioners & affiliated clinicians

Practitioners 54

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.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1962103549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 E COLUMBIA ST",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220463502",
            "telephone_number": "202-390-4243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 PRINCE WILLIAM PKWY STE 301",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221927667",
            "telephone_number": "202-390-4243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MENTAL HEALTH OF VIRGINIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "COLLEGIO",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "202-390-4243",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.