Healthcare Provider Details

I. General information

NPI: 1609644087
Provider Name (Legal Business Name): KAVANA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 S WASHINGTON ST STE 210 #1025
ALEXANDRIA VA
22314
US

IV. Provider business mailing address

277 S WASHINGTON ST, SUITE 210, #1025
ALEXANDRIA VA
22314-4127
US

V. Phone/Fax

Practice location:
  • Phone: 414-324-8283
  • Fax: 571-506-6004
Mailing address:
  • Phone: 703-249-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. AVITAL Y DESKALO
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 414-324-8283