Provider Demographics
NPI:1720863715
Name:NOORI, MOHAMMAD SEDIQ
Entity Type:Individual
Prefix:
First Name:MOHAMMAD SEDIQ
Middle Name:
Last Name:NOORI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 S GEORGE MASON DR UNIT 1414N
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-4702
Mailing Address - Country:US
Mailing Address - Phone:571-465-8192
Mailing Address - Fax:
Practice Address - Street 1:2050 OLD BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2484
Practice Address - Country:US
Practice Address - Phone:571-465-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst