Healthcare Provider Details

I. General information

NPI: 1447813506
Provider Name (Legal Business Name): NIKITA THADANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 MARK CENTER DR
ALEXANDRIA VA
22311-1882
US

IV. Provider business mailing address

13219 COPPERMILL DR
HERNDON VA
20171-3235
US

V. Phone/Fax

Practice location:
  • Phone: 703-746-3400
  • Fax:
Mailing address:
  • Phone: 703-439-4622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013666
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: