Provider Demographics
NPI:1902135684
Name:WASHINTON NEUROPSYCHOLOGY RESEARCH GROUP, LLC
Entity Type:Organization
Organization Name:WASHINTON NEUROPSYCHOLOGY RESEARCH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:WILKEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-876-0966
Mailing Address - Street 1:2629 OAKTON GLEN DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-5344
Mailing Address - Country:US
Mailing Address - Phone:703-876-0966
Mailing Address - Fax:703-876-1628
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE 103
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:703-876-0966
Practice Address - Fax:703-876-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003702103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty