Provider Demographics
NPI:1295386803
Name:ROPER, DAMARIS LYDIA
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:LYDIA
Last Name:ROPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 GOLANSKY BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4244
Mailing Address - Country:US
Mailing Address - Phone:703-401-0733
Mailing Address - Fax:703-436-9434
Practice Address - Street 1:3102 GOLANSKY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4244
Practice Address - Country:US
Practice Address - Phone:703-401-0733
Practice Address - Fax:703-436-9434
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst