Provider Demographics
NPI:1114332509
Name:MAIJALA, DAVIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVIN
Middle Name:
Last Name:MAIJALA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CONNECTICUT AVE NW STE 612
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1735
Mailing Address - Country:US
Mailing Address - Phone:202-656-0258
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 612
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1735
Practice Address - Country:US
Practice Address - Phone:202-656-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001024103T00000X, 103TC0700X
MNLP5580103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling