| |
42450 Fawn Meadow Pl Chantilly VA 20152-4177 | |
(540) 205-2998 | |
Not Available |
Full Name | |
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Speciality | Psychologist |
Location | 42450 Fawn Meadow Pl, Chantilly, Virginia |
Authorized Official Name and Position | Amber Parker (CLINICAL PSYCHOLOGIST) |
Authorized Official Contact | 5402052998 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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42450 Fawn Meadow Pl Chantilly VA 20152-4177 Ph: (540) 205-2998 | 42450 Fawn Meadow Pl Chantilly VA 20152-4177 Ph: (540) 205-2998 |
NPI Number | 1922532001 |
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Provider Enumeration Date | 04/17/2017 |
Last Update Date | 12/06/2024 |
Certification Date | 12/06/2024 |
Medicare PECOS PAC ID | 4284902636 |
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Medicare Enrollment ID | O20170608000381 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922532001 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | 0810004305 (Virginia) | Primary |
Provider Name | Amber Ls Parker |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1396013173 PECOS PAC ID: 6507094810 Enrollment ID: I20170608000593 |
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