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

Q: What is Convergence Mental Performance And Preparation Lab's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

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: August 09, 2026.

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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), doing business as Convergence Mental Performance Lab, 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

Phone(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

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Other Names 2

Doing Business AsConvergence Mental Performance Lab

Doing Business AsConvergence Prep

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 16

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

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