Provider Demographics
NPI:1700515780
Name:MISSIOS, PHOEBE MARY
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:MARY
Last Name:MISSIOS
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 1:3611 CHAIN BRIDGE RD STE C&D
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3246
Mailing Address - Country:US
Mailing Address - Phone:703-380-9045
Mailing Address - Fax:
Practice Address - Street 1:337 W MISSION AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1729
Practice Address - Country:US
Practice Address - Phone:760-745-0281
Practice Address - Fax:760-745-0778
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor