Provider Demographics
NPI:1437567161
Name:INSIGHT PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:INSIGHT PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:540-419-2215
Mailing Address - Street 1:2124 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7264
Mailing Address - Country:US
Mailing Address - Phone:540-419-2215
Mailing Address - Fax:
Practice Address - Street 1:2124 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7264
Practice Address - Country:US
Practice Address - Phone:540-419-2215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629378476Medicaid
VA1629378476Medicaid