Provider Demographics
NPI:1619066727
Name:PSYCHOLOGICAL AND LIFE SKILLS ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL AND LIFE SKILLS ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:703-490-0336
Mailing Address - Street 1:13885 HEDGEWOOD DR STE 245
Mailing Address - Street 2:PSYCHOLOGICAL AND LIFE SKILLS ASSOCIATES, P.C.
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-7931
Mailing Address - Country:US
Mailing Address - Phone:703-490-0336
Mailing Address - Fax:703-490-4525
Practice Address - Street 1:13885 HEDGEWOOD DR STE 245
Practice Address - Street 2:PSYCHOLOGICAL AND LIFE SKILLS ASSOCIATES, P.C.
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-7931
Practice Address - Country:US
Practice Address - Phone:703-490-0336
Practice Address - Fax:703-490-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08281Medicare ID - Type Unspecified