Healthcare Provider Details

I. General information

NPI: 1609780501
Provider Name (Legal Business Name): KATIE MEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 BELLE VIEW BLVD STE 735
ALEXANDRIA VA
22307-6531
US

IV. Provider business mailing address

8409 CROWN PL
ALEXANDRIA VA
22308-1825
US

V. Phone/Fax

Practice location:
  • Phone: 703-598-1555
  • Fax:
Mailing address:
  • Phone: 703-598-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberCP-580402
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: