Provider Demographics
NPI:1366221616
Name:ASG PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:ASG PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAFOORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-645-7414
Mailing Address - Street 1:14737 TRUITT FARM DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-5413
Mailing Address - Country:US
Mailing Address - Phone:919-645-7414
Mailing Address - Fax:
Practice Address - Street 1:14737 TRUITT FARM DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-5413
Practice Address - Country:US
Practice Address - Phone:919-645-7414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)