| Northern Virginia Psychology Professionals, Llc | |
|
1768 Business Center Dr Ste 360 Reston VA 20190-5358 | |
| (703) 662-3637 | |
| (703) 437-6872 |
| Full Name | Northern Virginia Psychology Professionals, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1768 Business Center Dr Ste 360, Reston, Virginia |
| Authorized Official Name and Position | Lauren Wall (CLINICAL PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 7036623637 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Virginia Psychology Professionals, Llc 1768 Business Center Dr Ste 360 Reston VA 20190-5358 Ph: (703) 662-3637 | Northern Virginia Psychology Professionals, Llc 1768 Business Center Dr Ste 360 Reston VA 20190-5358 Ph: (703) 662-3637 |
| NPI Number | 1811556434 |
|---|---|
| Provider Enumeration Date | 06/07/2019 |
| Last Update Date | 09/13/2021 |
| Certification Date | 09/13/2021 |
| Medicare PECOS PAC ID | 7618200379 |
|---|---|
| Medicare Enrollment ID | O20190612000048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811556434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Lauren Wall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578970224 PECOS PAC ID: 3173742236 Enrollment ID: I20151007001394 |
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