Provider Demographics
NPI:1538256581
Name:GARDNER, ALISON C (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:C
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 11TH ST N APT 8
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-2343
Mailing Address - Country:US
Mailing Address - Phone:703-597-1441
Mailing Address - Fax:
Practice Address - Street 1:11150 SUNSET HILLS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5360
Practice Address - Country:US
Practice Address - Phone:703-471-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical