Provider Demographics
NPI:1477601128
Name:FRETTA, NANCY CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:CAROL
Last Name:FRETTA
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 1:513 MAPLE AVE W
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4238
Mailing Address - Country:US
Mailing Address - Phone:703-938-4100
Mailing Address - Fax:703-281-4757
Practice Address - Street 1:513 MAPLE AVE W
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4238
Practice Address - Country:US
Practice Address - Phone:703-938-4100
Practice Address - Fax:703-281-4757
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000753103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810000753OtherVA STATE LICENSE