Provider Demographics
NPI:1003456336
Name:ALLIED PSYCHOLOGICAL ASSESSMENT SERVICES
Entity Type:Organization
Organization Name:ALLIED PSYCHOLOGICAL ASSESSMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DUSTI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SISK-FANDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:540-681-1669
Mailing Address - Street 1:PO BOX 5945
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22403-5945
Mailing Address - Country:US
Mailing Address - Phone:540-681-1669
Mailing Address - Fax:
Practice Address - Street 1:615 JEFFERSON DAVIS HWY STE 203
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8407
Practice Address - Country:US
Practice Address - Phone:540-681-1669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841597505Medicaid