Provider Demographics
NPI:1245619881
Name:PADDRIK, ELIZABETH WINE (PSYD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WINE
Last Name:PADDRIK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3603
Mailing Address - Country:US
Mailing Address - Phone:571-257-3378
Mailing Address - Fax:
Practice Address - Street 1:2001 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 211
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3603
Practice Address - Country:US
Practice Address - Phone:571-257-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist