Clementine Twin Lakes, LLC

NPI #1033970603 in Mc Lean, Virginia

Provider Information

NPI Number: 1033970603
Entity Type: Organization
Organization Name: Clementine Twin Lakes, LLC
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Jan 19, 2024
Last Updated: Jun 26, 2024

Practice Location

Address: 8180 GREENSBORO DR STE 375
City: Mc Lean
State: Virginia
ZIP Code: 22102-3888
Phone: (571) 569-4929

Authorized Official

Name: MR. EDWARD MOODY
Title: CHIEF FINANCIAL OFFICER
Phone: (571) 334-3144

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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