is a Clinical in Herndon, Virginia. practices all healthcare services and medical treatments related to Clinical. The NPI Number for is 1790896504. The last update date is .
's current location address is 2579 John Milton Dr Ste 210, Herndon, Virginia. You can contact this provider via phone number 7032144924 and fax number 7032144925. The mailing address for is 2579 John Milton Dr Ste 210, Herndon, Virginia. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 2579 John Milton Dr Ste 210, Herndon, Virginia |
| Phone Number | 7032144924 |
| Fax Number | 7032144925 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1790896504 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 2579 John Milton Dr Ste 210 |
|---|---|
| City | Herndon |
| State | Virginia (VA) |
| Post Code | 201712564 |
| Phone Number | 7032144924 |
| Fax Number | 7032144925 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 103Tc0700X |
| Licence No | 810002926 |
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Definition: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 245996 | VA | ANTHEM BCBS |
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