Provider Demographics
NPI:1902969132
Name:SAMPSON, NICOLE R (PHD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 LITTLE FALLS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22213-1209
Mailing Address - Country:US
Mailing Address - Phone:202-412-5966
Mailing Address - Fax:
Practice Address - Street 1:6512 LITTLE FALLS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22213-1209
Practice Address - Country:US
Practice Address - Phone:202-412-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003673103T00000X
DCPSY1000119103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist