Provider Demographics
NPI:1013247618
Name:ANSARI, GAZALA ABULHASAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAZALA
Middle Name:ABULHASAN
Last Name:ANSARI
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 1:2331 MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4677
Mailing Address - Country:US
Mailing Address - Phone:703-224-8983
Mailing Address - Fax:703-224-8801
Practice Address - Street 1:2331 MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4677
Practice Address - Country:US
Practice Address - Phone:703-224-8983
Practice Address - Fax:703-224-8801
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103TF0200X, 103TM1800X
VA0810004131103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities