Provider Demographics
NPI:1679781413
Name:FORD, KATHRYN ARNOLD (PHD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ARNOLD
Last Name:FORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6842 ELM ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3891
Mailing Address - Country:US
Mailing Address - Phone:703-790-5082
Mailing Address - Fax:
Practice Address - Street 1:6842 ELM ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3891
Practice Address - Country:US
Practice Address - Phone:703-790-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical