Healthcare Provider Details

I. General information

NPI: 1962024034
Provider Name (Legal Business Name): CHAO SONG PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTURY DR APT 7214
ALEXANDRIA VA
22304-5795
US

IV. Provider business mailing address

100 CENTURY DR APT 7214
ALEXANDRIA VA
22304-5795
US

V. Phone/Fax

Practice location:
  • Phone: 202-556-4676
  • Fax:
Mailing address:
  • Phone: 202-556-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009232
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: