Provider Demographics
NPI:1164446662
Name:GOSS, MICHELE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:D
Last Name:GOSS
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 1:205 S WHITING ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7100
Mailing Address - Country:US
Mailing Address - Phone:703-795-0938
Mailing Address - Fax:703-491-4943
Practice Address - Street 1:205 S WHITING ST
Practice Address - Street 2:SUITE 603
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7100
Practice Address - Country:US
Practice Address - Phone:703-795-0938
Practice Address - Fax:703-491-4943
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical