Provider Demographics
NPI:1114063195
Name:NACKMAN, DEBRA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:M
Last Name:NACKMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 MANTUA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2712
Mailing Address - Country:US
Mailing Address - Phone:703-645-8700
Mailing Address - Fax:703-533-9433
Practice Address - Street 1:405 N WASHINGTON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3410
Practice Address - Country:US
Practice Address - Phone:703-645-8700
Practice Address - Fax:703-533-9433
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001415103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical