Provider Demographics
NPI:1154451524
Name:KHELLAF, SALAH C (PHD)
Entity Type:Individual
Prefix:
First Name:SALAH
Middle Name:C
Last Name:KHELLAF
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 1:10560 MAIN ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7173
Mailing Address - Country:US
Mailing Address - Phone:703-691-1326
Mailing Address - Fax:703-691-3553
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:SUITE 507
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7173
Practice Address - Country:US
Practice Address - Phone:703-691-1326
Practice Address - Fax:703-691-3553
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
647334Medicare ID - Type Unspecified