Healthcare Provider Details

I. General information

NPI: 1033064340
Provider Name (Legal Business Name): XINWEI DONG
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7578 MORRIS ST
FULTON MD
20759-2307
US

IV. Provider business mailing address

7578 MORRIS ST
FULTON MD
20759-2307
US

V. Phone/Fax

Practice location:
  • Phone: 443-875-2649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009304
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: