CONVERGENCE MENTAL PERFORMANCE AND PREPARATION LAB
NPI 1346015815
Social Worker - Clinical in Fairfax, VA

Active since November 15, 2023
4000 LEGATO RD STE 1100, FAIRFAX, VA 22033(571) 336-2272 Get Directions Write a Review

NPPES record last updated: November 15, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Convergence Mental Performance And Preparation Lab NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CONVERGENCE MENTAL PERFORMANCE AND PREPARATION LAB (NPI 1346015815) is a healthcare organization registered as a clinical in Fairfax, Virginia and active in the NPI registry since November 2023. The organization lists Tawana Butler, Owner/ceo, as its authorized official.

NPPES Registry Identity

NPI1346015815
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameCONVERGENCE MENTAL PERFORMANCE AND PREPARATION LAB
Location Address4000 LEGATO RD STE 1100Fairfax, VA 22033-2893
Mailing Address15000 Potomac Town Pl Ste 100-151Woodbridge, VA 22191-6586 · (571) 336-2272
Organization SubpartNo
Authorized OfficialTawana ButlerOwner/ceo · (817) 913-5428
Enumeration DateNovember 15, 2023
NPPES CertifiedNovember 15, 2023
NPI 1346015815 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Also ListedCounselor · ProfessionalTaxonomy 101YP2500X
Also ListedPsychologist · Exercise & SportsTaxonomy 103TE1100X
4000 LEGATO RD STE 1100, Fairfax, VA 22033

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Family Medicine
4000 LEGATO RD STE 1100
FAIRFAX, VA 22033
Licensed Practical Nurse
4000 LEGATO RD STE 1100
FAIRFAX, VA 22033
Non-emergency Medical Transport (VAN)
4000 LEGATO RD STE 1100
FAIRFAX, VA 22033
Home Health
4000 LEGATO RD STE 1100
FAIRFAX, VA 22033
Clinic/Center (Mental Health (Including Community Mental Health Center))
4000 LEGATO RD STE 1100
FAIRFAX, VA 22033
Counselor (Mental Health)
4000 LEGATO RD STE 1100
FAIRFAX, VA 22033
Nurse Practitioner (Psychiatric/Mental Health)
4000 LEGATO RD STE 1100
FAIRFAX, VA 22033
Social Worker (Clinical)
4000 LEGATO RD STE 1100
FAIRFAX, VA 22033

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1346015815, enumerated as an "organization" on November 15, 2023.

The provider is located at 4000 LEGATO RD STE 1100 FAIRFAX, VA 22033 and the phone number is (571) 336-2272.

Social Worker with taxonomy code 1041C0700X and a focus in Clinical.