Provider Demographics
NPI:1194930248
Name:KOZMA, KATHLEEN DIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:DIANE
Last Name:KOZMA
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 1:20604 GORDON PARK SQ
Mailing Address - Street 2:#190
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3143
Mailing Address - Country:US
Mailing Address - Phone:703-726-7544
Mailing Address - Fax:
Practice Address - Street 1:20604 GORDON PARK SQ
Practice Address - Street 2:#190
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3143
Practice Address - Country:US
Practice Address - Phone:703-726-7544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical