Provider Demographics
NPI:1356945356
Name:ABUTAAH, DANIA YASSIN
Entity type:Individual
Prefix:
First Name:DANIA
Middle Name:YASSIN
Last Name:ABUTAAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25740 CELBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIDING
Mailing Address - State:VA
Mailing Address - Zip Code:20152-2576
Mailing Address - Country:US
Mailing Address - Phone:703-606-8140
Mailing Address - Fax:
Practice Address - Street 1:25740 CELBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-2576
Practice Address - Country:US
Practice Address - Phone:703-606-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician