Provider Demographics
NPI:1710768114
Name:JAMES, NATASIA NICOLE
Entity Type:Individual
Prefix:
First Name:NATASIA
Middle Name:NICOLE
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LUNA PARK DR APT 111
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-3142
Mailing Address - Country:US
Mailing Address - Phone:910-800-0510
Mailing Address - Fax:
Practice Address - Street 1:200 LUNA PARK DR APT 111
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-3142
Practice Address - Country:US
Practice Address - Phone:910-800-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty