Provider Demographics
NPI:1922196658
Name:ROHRER, NICHOLE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:M
Last Name:ROHRER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NICHOLE
Other - Middle Name:M
Other - Last Name:ROHRER-BASSINGTHWAITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1008 BASHFORD LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1321
Mailing Address - Country:US
Mailing Address - Phone:703-549-5412
Mailing Address - Fax:
Practice Address - Street 1:720 N SAINT ASAPH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1912
Practice Address - Country:US
Practice Address - Phone:703-838-6376
Practice Address - Fax:703-838-5070
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945026Medicaid