Provider Demographics
NPI:1619506854
Name:VITALE, ANITA MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:VITALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:MARIE
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANITA ALEXANDER, MS
Mailing Address - Street 1:43748 WELTY CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5850
Mailing Address - Country:US
Mailing Address - Phone:703-894-8264
Mailing Address - Fax:
Practice Address - Street 1:3023 HAMAKER CT STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2240
Practice Address - Country:US
Practice Address - Phone:703-876-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006450103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical