Provider Demographics
NPI:1588672273
Name:ROMAN, ALISA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:M
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6101 KINGS COLOR DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5916
Mailing Address - Country:US
Mailing Address - Phone:703-385-0196
Mailing Address - Fax:703-385-0197
Practice Address - Street 1:11244 WAPLES MILL RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6040
Practice Address - Country:US
Practice Address - Phone:703-385-0196
Practice Address - Fax:703-385-0197
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810001888103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical