Provider Demographics
NPI:1750455937
Name:DIERKER, GLORY FOX (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORY
Middle Name:FOX
Last Name:DIERKER
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 1:5691 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041
Mailing Address - Country:US
Mailing Address - Phone:703-998-5606
Mailing Address - Fax:703-998-5608
Practice Address - Street 1:5691 COLUMBIA PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041
Practice Address - Country:US
Practice Address - Phone:703-998-5606
Practice Address - Fax:703-998-5608
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07010001557101YP2500X
VA0810002996103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
149749000OtherDEPARTMENT OF LABOR
28110004OtherARLINGTON EAP PROVIDERS
2122848OtherMAMSI
VA7713690Medicaid
2811004OtherCAREFIRST
VA2811004OtherCAREFIRST
2129080OtherFIRST HEALTH
0972793OtherAETNA
141701OtherANTHEM BCBS
461335000OtherMAGELLAN
541521659OtherAMERICAN BEHAVIORAL HLTH
28110004OtherCARE FIRST
4481805OtherAETNA
541521659OtherUNITED BEHAVIORAL HEALTH