49D2229962 CLIA NUMBER - CLEMENTINE FAIRFAX

Laboratory Demographics

  • CLIA Code: 49D2229962
  • Facility Name: CLEMENTINE FAIRFAX
  • Facility Address: 11329 HENDERSON RD
    FAIRFAX STATION, VA
    ZIP 22039
  • Facility Phone: 571 655-6440
  • Facility Type: Other - RESIDENTIAL MENTAL HLTH
  • Facility Type: Waiver
  • Lab Director: MOLLY M. PERLMAN
  • NPI Number: 1689269250
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 49D2229962
LAB Type Other - RESIDENTIAL MENTAL HLTH
Facility Name CLEMENTINE FAIRFAX
Street 11329 HENDERSON RD
City FAIRFAX STATION
State VA
ZIP 22039
Phone 571 655-6440
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2025
Certificate Expiration Date 7/18/2027
Facility Type Other - RESIDENTIAL MENTAL HLTH
Lab Director MOLLY M. PERLMAN

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This page was last updated on: 9/29/2025