Provider Demographics
NPI:1538923685
Name:VIVACITYPSYCH INC
Entity type:Organization
Organization Name:VIVACITYPSYCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HENNA
Authorized Official - Middle Name:ZEHRA
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:540-254-7899
Mailing Address - Street 1:235 GARRISONVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1552
Mailing Address - Country:US
Mailing Address - Phone:540-254-7899
Mailing Address - Fax:
Practice Address - Street 1:235 GARRISONVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1552
Practice Address - Country:US
Practice Address - Phone:540-254-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty