Provider Demographics
NPI:1285776641
Name:CHERYL A. COLECCHI, PH.D., P.C.
Entity type:Organization
Organization Name:CHERYL A. COLECCHI, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLECCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-751-0255
Mailing Address - Street 1:205 S WHITING ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7100
Mailing Address - Country:US
Mailing Address - Phone:703-751-0255
Mailing Address - Fax:703-751-4943
Practice Address - Street 1:205 S WHITING ST
Practice Address - Street 2:SUITE 603
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7100
Practice Address - Country:US
Practice Address - Phone:703-751-0255
Practice Address - Fax:703-751-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAK689OtherCAREFIRST BLUE CROSS BLUE
VA2031456OtherCIGNA BEHAVIORAL HEALTH
VA083157OtherANTHEM BLUE CROSS BLUE SH
VA254590000OtherMAGELLAN BEHAVIORAL HEALT
VA722925OtherNCPPO
VA374830OtherMHN TRICARE
VA080178OtherSENTARA
VA5850280OtherAETNA
VA188815OtherVALUEOPTIONS
VAK689OtherCAREFIRST BLUE CROSS BLUE