Provider Demographics
NPI:1609894286
Name:NOVA PSYCHIATRIC SERVICES PC
Entity Type:Organization
Organization Name:NOVA PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-444-7792
Mailing Address - Street 1:21351 GENTRY DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8510
Mailing Address - Country:US
Mailing Address - Phone:703-444-7792
Mailing Address - Fax:703-421-9946
Practice Address - Street 1:21351 GENTRY DR
Practice Address - Street 2:SUITE 250
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8510
Practice Address - Country:US
Practice Address - Phone:703-444-7792
Practice Address - Fax:703-421-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012366002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty