Provider Demographics
NPI:1700672557
Name:FISSEHA, FEVEN (PHD)
Entity type:Individual
Prefix:DR
First Name:FEVEN
Middle Name:
Last Name:FISSEHA
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 1:12700 NORTHCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4723
Mailing Address - Country:US
Mailing Address - Phone:240-475-2734
Mailing Address - Fax:
Practice Address - Street 1:2000 15TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-2627
Practice Address - Country:US
Practice Address - Phone:703-988-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008881103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical