Provider Demographics
NPI:1851174510
Name:GEORGE MASON UNIVERSITY
Entity type:Organization
Organization Name:GEORGE MASON UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEADLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-993-5127
Mailing Address - Street 1:4400 UNIVERSITY DR # MS 4B6
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4455 GEORGE MASON BLVD.
Practice Address - Street 2:THOMPSON HALL L040
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-993-3938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE MASON UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health