Provider Demographics
NPI:1255674206
Name:PROFESSIONAL PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TASHNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FELIX
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, CSOTP
Authorized Official - Phone:703-828-7115
Mailing Address - Street 1:3331 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3331 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4597
Practice Address - Country:US
Practice Address - Phone:703-828-7115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health