Provider Demographics
NPI:1306987045
Name:LALLY, STEPHEN JAMES (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
Last Name:LALLY
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2501
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-0501
Mailing Address - Country:US
Mailing Address - Phone:703-527-1111
Mailing Address - Fax:
Practice Address - Street 1:1655 FORT MYER DR
Practice Address - Street 2:SUITE 700
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-3113
Practice Address - Country:US
Practice Address - Phone:703-527-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1532103T00000X
MD2529103T00000X
NC1540103T00000X
VA2182103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical