Provider Demographics
NPI:1730726290
Name:KHARDI, FADWA
Entity type:Individual
Prefix:
First Name:FADWA
Middle Name:
Last Name:KHARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 WAPLES MILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7475
Mailing Address - Country:US
Mailing Address - Phone:703-237-2219
Mailing Address - Fax:
Practice Address - Street 1:2446 S OAKLAND ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2432
Practice Address - Country:US
Practice Address - Phone:202-247-5576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician