Provider Demographics
NPI:1760598312
Name:WEBER, JILL PARKS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:PARKS
Last Name:WEBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7927 JONES BRANCH DR
Mailing Address - Street 2:SUITE: 6125
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3322
Mailing Address - Country:US
Mailing Address - Phone:703-541-1277
Mailing Address - Fax:703-992-0993
Practice Address - Street 1:7927 JONES BRANCH DR
Practice Address - Street 2:SUITE: 6125
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3322
Practice Address - Country:US
Practice Address - Phone:703-541-1277
Practice Address - Fax:703-992-0993
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical