Provider Demographics
NPI:1205398591
Name:THOMAS, MEGAN (PSYD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 CHAIN BRIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2709
Mailing Address - Country:US
Mailing Address - Phone:703-896-7628
Mailing Address - Fax:
Practice Address - Street 1:3554 CHAIN BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2709
Practice Address - Country:US
Practice Address - Phone:703-896-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008460103TC0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician