Provider Demographics
NPI:1548459381
Name:HIATT, GINA ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:ELLEN
Last Name:HIATT
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 1:6845 ELM ST
Mailing Address - Street 2:SUITE 710
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-6007
Mailing Address - Country:US
Mailing Address - Phone:703-734-4945
Mailing Address - Fax:703-734-1441
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:SUITE 710
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:703-734-4945
Practice Address - Fax:703-734-1441
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1770103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical