Provider Demographics
NPI:1811244460
Name:IVANKOVIC, MAJA N/A (PSYD)
Entity type:Individual
Prefix:MS
First Name:MAJA
Middle Name:N/A
Last Name:IVANKOVIC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 511
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3603
Mailing Address - Country:US
Mailing Address - Phone:703-416-1441
Mailing Address - Fax:703-418-2112
Practice Address - Street 1:2001 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 511
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3603
Practice Address - Country:US
Practice Address - Phone:703-416-1441
Practice Address - Fax:703-418-2112
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004957103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical