Provider Demographics
NPI:1982236709
Name:PIVOTAL PSYCH CONSULTANTS
Entity Type:Organization
Organization Name:PIVOTAL PSYCH CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:FLEITAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-200-4193
Mailing Address - Street 1:500 N WASHINGTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2314
Mailing Address - Country:US
Mailing Address - Phone:202-796-8727
Mailing Address - Fax:202-888-3554
Practice Address - Street 1:500 N WASHINGTON ST STE 205
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2314
Practice Address - Country:US
Practice Address - Phone:703-200-4193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHOLOGICAL ASSESSMENT SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty