Provider Demographics
NPI:1740423144
Name:MATHISON, JASON (PSYD, NCSP, ABSNP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MATHISON
Suffix:
Gender:M
Credentials:PSYD, NCSP, ABSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7283 SWAN POINT WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5059
Mailing Address - Country:US
Mailing Address - Phone:703-967-0631
Mailing Address - Fax:
Practice Address - Street 1:407 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-2233
Practice Address - Country:US
Practice Address - Phone:703-967-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0803000222103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool