Provider Demographics
NPI:1124043419
Name:HEBDA, DAVID W (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:HEBDA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 ASHTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5698
Mailing Address - Country:US
Mailing Address - Phone:703-587-8312
Mailing Address - Fax:703-495-9409
Practice Address - Street 1:8140 ASHTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5698
Practice Address - Country:US
Practice Address - Phone:703-587-8312
Practice Address - Fax:703-495-9409
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002258103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA224308OtherANTHEM BCBS
VA190000722Medicare ID - Type Unspecified
VAHE674514Medicare ID - Type UnspecifiedSECOND PROVIDER NUMBER