| Self Knowledge Base And Foundation | |
|
43803 Michener Dr Ashburn VA 20147-5807 | |
| (703) 443-4924 | |
| (703) 775-1560 |
| Full Name | Self Knowledge Base And Foundation |
|---|---|
| Speciality | Psychologist |
| Location | 43803 Michener Dr, Ashburn, Virginia |
| Authorized Official Name and Position | Michelle Rad (OWNER) |
| Authorized Official Contact | 7034434924 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Self Knowledge Base And Foundation 43803 Michener Dr Ashburn VA 20147-5807 Ph: (703) 443-4924 | Self Knowledge Base And Foundation 43803 Michener Dr Ashburn VA 20147-5807 Ph: (703) 443-4924 |
| NPI Number | 1780467993 |
|---|---|
| Provider Enumeration Date | 08/14/2023 |
| Last Update Date | 08/14/2023 |
| Certification Date | 08/14/2023 |
| Medicare PECOS PAC ID | 3971946617 |
|---|---|
| Medicare Enrollment ID | O20240208004426 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780467993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michelle Rad |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720459746 PECOS PAC ID: 9133595630 Enrollment ID: I20221025003020 |
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