Provider Demographics
NPI:1962380030
Name:KHAWAR, ISHA
Entity type:Individual
Prefix:
First Name:ISHA
Middle Name:
Last Name:KHAWAR
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 1:25216 DUNVEGAN SQ
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5305
Mailing Address - Country:US
Mailing Address - Phone:571-201-3810
Mailing Address - Fax:
Practice Address - Street 1:24805 PINEBROOK RD STE 312
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4128
Practice Address - Country:US
Practice Address - Phone:703-496-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA65988184106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician