Provider Demographics
NPI:1447669320
Name:DASH, RAHMELL
Entity type:Individual
Prefix:
First Name:RAHMELL
Middle Name:
Last Name:DASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12566 SUMMIT MANOR DR
Mailing Address - Street 2:SUITE 222
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5704
Mailing Address - Country:US
Mailing Address - Phone:917-670-2651
Mailing Address - Fax:
Practice Address - Street 1:14000 CROWN CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1460
Practice Address - Country:US
Practice Address - Phone:917-670-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2387Medicaid