Provider Demographics
NPI:1245355197
Name:NORTHERN VIRGINIA PSYCHOTHERAPY ASSOC., INC.
Entity type:Organization
Organization Name:NORTHERN VIRGINIA PSYCHOTHERAPY ASSOC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-742-6043
Mailing Address - Street 1:297 HERNDON PKWY
Mailing Address - Street 2:STE. 201
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170
Mailing Address - Country:US
Mailing Address - Phone:703-742-6043
Mailing Address - Fax:
Practice Address - Street 1:297 HERNDON PKWY
Practice Address - Street 2:STE. 201
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4474
Practice Address - Country:US
Practice Address - Phone:703-742-6043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN VIRGINIA PSYCHOTHERAPY ASSOC., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040014151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty