Provider Demographics
NPI:1326934621
Name:RUMPH, CHANIECE (PMHNP)
Entity type:Individual
Prefix:
First Name:CHANIECE
Middle Name:
Last Name:RUMPH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 FAIRFAX DR STE 600
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1665
Mailing Address - Country:US
Mailing Address - Phone:240-820-3557
Mailing Address - Fax:
Practice Address - Street 1:8000 TOWERS CRESCENT DR
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-6207
Practice Address - Country:US
Practice Address - Phone:240-820-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0039451363LP0808X
NY3542492363LP0808X
GANCO-000003363LP0808X
VA0024194548363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health