Provider Demographics
NPI:1255086849
Name:GALA, NICHOLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:GALA
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 1:4165 S FOUR MILE RUN DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-3972
Mailing Address - Country:US
Mailing Address - Phone:585-217-3807
Mailing Address - Fax:
Practice Address - Street 1:12359 SUNRISE VALLEY DR STE 320
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3463
Practice Address - Country:US
Practice Address - Phone:703-596-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000789103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical