Provider Demographics
NPI:1669021820
Name:YOUSUFZAI, ABDUL M
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:M
Last Name:YOUSUFZAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14608 THERA WAY
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3451
Mailing Address - Country:US
Mailing Address - Phone:703-286-9878
Mailing Address - Fax:703-815-1459
Practice Address - Street 1:14608 THERA WAY
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-3451
Practice Address - Country:US
Practice Address - Phone:703-286-9878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-19-83448106S00000X
VA0134000309106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician