Provider Demographics
NPI:1699212126
Name:NEUROPSYCHOLOGY OF NORTHERN VIRGINIA
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY OF NORTHERN VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/ NEUROPSYCHO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HEBDA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-587-8312
Mailing Address - Street 1:8140 ASHTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5698
Mailing Address - Country:US
Mailing Address - Phone:703-587-8312
Mailing Address - Fax:703-495-9409
Practice Address - Street 1:8140 ASHTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5698
Practice Address - Country:US
Practice Address - Phone:703-587-8312
Practice Address - Fax:703-495-9409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002258103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124043419Medicare UPIN