Provider Demographics
NPI:1750046538
Name:UNDERWOOD, CECILIA M
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:M
Last Name:UNDERWOOD
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 1:8391 OLD COURTHOUSE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3819
Mailing Address - Country:US
Mailing Address - Phone:703-429-1853
Mailing Address - Fax:301-718-1766
Practice Address - Street 1:8391 OLD COURTHOUSE RD STE 120
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3819
Practice Address - Country:US
Practice Address - Phone:703-429-1853
Practice Address - Fax:301-718-1766
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133003808103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRBT-21-188557OtherBACB