Healthcare Provider Details

I. General information

NPI: 1740423144
Provider Name (Legal Business Name): JASON MATHISON PSY.D, NCSP, ABSNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 MOUNT VERNON AVE
ALEXANDRIA VA
22301-2233
US

IV. Provider business mailing address

7283 SWAN POINT WAY
COLUMBIA MD
21045-5059
US

V. Phone/Fax

Practice location:
  • Phone: 703-967-0631
  • Fax:
Mailing address:
  • Phone: 703-967-0631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0803000222
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: