Provider Demographics
NPI:1982891347
Name:HAEFNER, PAUL THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:HAEFNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WIRT ST, SW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175
Mailing Address - Country:US
Mailing Address - Phone:703-777-1122
Mailing Address - Fax:
Practice Address - Street 1:210 WIRT ST SW
Practice Address - Street 2:SUITE 102
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2929
Practice Address - Country:US
Practice Address - Phone:703-777-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002093103TC0700X, 103TC2200X, 103TE1100X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy