Provider Demographics
NPI:1285793539
Name:PSYCHIATRIC & COUNSELING CENTER OF NORTHERN VIRGINIA
Entity type:Organization
Organization Name:PSYCHIATRIC & COUNSELING CENTER OF NORTHERN VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELAWTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-257-8401
Mailing Address - Street 1:9244 CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5551
Mailing Address - Country:US
Mailing Address - Phone:703-257-8401
Mailing Address - Fax:703-257-8403
Practice Address - Street 1:9244 CENTER STREET
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5551
Practice Address - Country:US
Practice Address - Phone:703-257-8401
Practice Address - Fax:703-257-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0600001194OtherBUSINESS LICENSE
VAC04578Medicare ID - Type Unspecified