Provider Demographics
NPI:1922651033
Name:HEALTHY LIVING PSYCHOLOGY
Entity Type:Organization
Organization Name:HEALTHY LIVING PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-345-6928
Mailing Address - Street 1:9840 MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3909
Mailing Address - Country:US
Mailing Address - Phone:703-344-6218
Mailing Address - Fax:
Practice Address - Street 1:9840 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3909
Practice Address - Country:US
Practice Address - Phone:703-344-6218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty