Provider Demographics
NPI:1972099372
Name:SOGGIN, GYOEN G (PSYD)
Entity type:Individual
Prefix:DR
First Name:GYOEN
Middle Name:G
Last Name:SOGGIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6723 WHITTIER AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4544
Mailing Address - Country:US
Mailing Address - Phone:571-353-5110
Mailing Address - Fax:
Practice Address - Street 1:6723 WHITTIER AVE STE 207
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4544
Practice Address - Country:US
Practice Address - Phone:571-353-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002618103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty