| Jeanine R. Carlson, Phd, Llc | |
|
1487 Chain Bridge Rd Ste 202 Mc Lean VA 22101-5723 | |
| (703) 919-0917 | |
| Not Available |
| Full Name | Jeanine R. Carlson, Phd, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1487 Chain Bridge Rd Ste 202, Mc Lean, Virginia |
| Authorized Official Name and Position | Jeanine R Carlson (OWNER) |
| Authorized Official Contact | 7039190917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeanine R. Carlson, Phd, Llc 1487 Chain Bridge Rd Ste 202 Mc Lean VA 22101-5723 Ph: (703) 919-0917 | Jeanine R. Carlson, Phd, Llc 1487 Chain Bridge Rd Ste 202 Mc Lean VA 22101-5723 Ph: (703) 919-0917 |
| NPI Number | 1144570771 |
|---|---|
| Provider Enumeration Date | 09/11/2012 |
| Last Update Date | 09/11/2012 |
| Medicare PECOS PAC ID | 8224275359 |
|---|---|
| Medicare Enrollment ID | O20130509000466 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144570771 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | VA2078 (Virginia) | Primary |
| Provider Name | Jeanine R Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972794642 PECOS PAC ID: 8527219880 Enrollment ID: I20150901002990 |
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