Healthcare Provider Details

I. General information

NPI: 1134627797
Provider Name (Legal Business Name): STEPHANIE B. TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24560 SOUTHPOINT DR STE 260
ALDIE VA
20105-3505
US

IV. Provider business mailing address

24560 SOUTHPOINT DR STE 260
ALDIE VA
20105-3505
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-7472
  • Fax: 571-248-7493
Mailing address:
  • Phone: 571-248-7472
  • Fax: 571-248-7493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0104551
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101267489
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: