Provider Demographics
NPI:1790994853
Name:SAHNI, CAROLYN JACKSON (PHD)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:JACKSON
Last Name:SAHNI
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 1:922 NINOVAN RD SE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5970
Mailing Address - Country:US
Mailing Address - Phone:703-281-3172
Mailing Address - Fax:703-281-7832
Practice Address - Street 1:922 NINOVAN RD SE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:703-281-4850
Practice Address - Fax:703-281-7832
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001239103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541462621Medicaid
VA56-2641681Medicaid
VA56-2641681Medicare PIN