Healthcare Provider Details

I. General information

NPI: 1013247618
Provider Name (Legal Business Name): GAZALA ABULHASAN ANSARI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 MILL RD SUITE 100
ALEXANDRIA VA
22314-4677
US

IV. Provider business mailing address

2331 MILL RD SUITE 100
ALEXANDRIA VA
22314-4677
US

V. Phone/Fax

Practice location:
  • Phone: 703-224-8983
  • Fax: 703-224-8801
Mailing address:
  • Phone: 703-224-8983
  • Fax: 703-224-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004131
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: