Old Town Professional Psychology
Psychologist, Clinical in Alexandria, VA. Organization (NPI-2).
NPI number1366063992
StatusActive
Last updated in NPPESMay 13, 2020
Details
- NPI
- 1366063992
- Entity type
- Organization (NPI-2)
- Legal business name
- Old Town Professional Psychology
- Organization subpart
- No
- Enumeration date
- May 5, 2020
- Certification date
- May 13, 2020
- Last updated
- May 13, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | – | – | Yes |
| 102L00000X | Psychoanalyst | – | – | |
| 103G00000X | Clinical Neuropsychologist | – | – | |
| 103TP0814X | Psychologist, Psychoanalysis | – | – |
Practice location
411 1/2 N Washington StAlexandria, VA 22314-2311
Phone 571-327-0194
Mailing address
411 1/2 N Washington StAlexandria, VA 22314-2311
Phone 540-931-5238
Authorized official
Sundar Cook
Psychologist
5409315238
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