Provider Demographics
NPI:1952467664
Name:DURANA, CARLOS (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:DURANA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11417 TANBARK DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4103
Mailing Address - Country:US
Mailing Address - Phone:703-620-4509
Mailing Address - Fax:703-620-0420
Practice Address - Street 1:11417 TANBARK DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-4103
Practice Address - Country:US
Practice Address - Phone:703-620-4509
Practice Address - Fax:703-620-0420
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002622103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical