Healthcare Provider Details

I. General information

NPI: 1033455803
Provider Name (Legal Business Name): NEW STRESS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2012
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5194 DAWES AVE
ALEXANDRIA VA
22311
US

IV. Provider business mailing address

5194 DAWES AVE
ALEXANDRIA VA
22311-1402
US

V. Phone/Fax

Practice location:
  • Phone: 301-674-2742
  • Fax:
Mailing address:
  • Phone: 301-674-2742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0101053989
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMD21377
License Number StateDC

VIII. Authorized Official

Name: RAMA S PRAYAGA
Title or Position: MD
Credential: M.D
Phone: 301-674-2742