Provider Demographics
NPI:1497212930
Name:MAHR, NIDDA ASIF
Entity Type:Individual
Prefix:
First Name:NIDDA
Middle Name:ASIF
Last Name:MAHR
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 1:8864 CHEROKEE ROSE WAY
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-5632
Mailing Address - Country:US
Mailing Address - Phone:703-608-7863
Mailing Address - Fax:
Practice Address - Street 1:7617 LITTLE RIVER TPKE STE 110
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2603
Practice Address - Country:US
Practice Address - Phone:571-355-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
VA0133002139103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician