Provider Demographics
NPI:1013225069
Name:PSYCHOLOGY ASSOCIATES OF NORTHERN VIRGINIA, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGY ASSOCIATES OF NORTHERN VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABU-HAMDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-356-9136
Mailing Address - Street 1:PO BOX 1858
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20122-8858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1954 OPITZ BLVD # 7
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3304
Practice Address - Country:US
Practice Address - Phone:703-356-9136
Practice Address - Fax:703-492-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty