Provider Demographics
NPI:1841470218
Name:S. MARK CROSS, PHD, P.C.
Entity type:Organization
Organization Name:S. MARK CROSS, PHD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:S.
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-533-5825
Mailing Address - Street 1:4132 MINTON DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1131
Mailing Address - Country:US
Mailing Address - Phone:703-533-5825
Mailing Address - Fax:703-533-8431
Practice Address - Street 1:109 PARK WASHINGTON CT
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4519
Practice Address - Country:US
Practice Address - Phone:703-533-5825
Practice Address - Fax:703-533-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty