Provider Demographics
NPI:1518629971
Name:MASON, AISHA (MED)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14702 VILLAGE SQUARE PL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2253
Mailing Address - Country:US
Mailing Address - Phone:434-962-9730
Mailing Address - Fax:
Practice Address - Street 1:14700 VILLAGE SQUARE PL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2253
Practice Address - Country:US
Practice Address - Phone:434-962-9730
Practice Address - Fax:276-597-5158
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704008718101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor