Provider Demographics
NPI:1548734460
Name:DUFF, JOHNATHAN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:
Last Name:DUFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5691 COLUMBIA PIKE STE 200
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2888
Mailing Address - Country:US
Mailing Address - Phone:703-998-5606
Mailing Address - Fax:
Practice Address - Street 1:5691 COLUMBIA PIKE STE 200
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2888
Practice Address - Country:US
Practice Address - Phone:703-998-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005803103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist